Provider Demographics
NPI:1164874129
Name:FENIX BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:FENIX BEHAVIORAL HEALTH LLC
Other - Org Name:FENIX BEHAVIORAL HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASER
Authorized Official - Middle Name:
Authorized Official - Last Name:ONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-421-4132
Mailing Address - Street 1:725 DOBBINS ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2831
Mailing Address - Country:US
Mailing Address - Phone:561-860-8525
Mailing Address - Fax:
Practice Address - Street 1:2247 PALM BEACH LAKES BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3409
Practice Address - Country:US
Practice Address - Phone:561-421-4132
Practice Address - Fax:561-774-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164874129OtherNPI