Provider Demographics
NPI:1164952164
Name:RISING PHOENIX COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:RISING PHOENIX COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:EILERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, CCTP
Authorized Official - Phone:541-500-7111
Mailing Address - Street 1:810 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6773
Mailing Address - Country:US
Mailing Address - Phone:541-500-7111
Mailing Address - Fax:541-507-9118
Practice Address - Street 1:810 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6773
Practice Address - Country:US
Practice Address - Phone:541-500-7111
Practice Address - Fax:541-507-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty