Provider Demographics
NPI:1235740929
Name:PHOENIX RISING THERAPY, LLC
Entity Type:Organization
Organization Name:PHOENIX RISING THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREUDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:541-321-0788
Mailing Address - Street 1:3575 DONALD ST STE 240
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4759
Mailing Address - Country:US
Mailing Address - Phone:541-321-0788
Mailing Address - Fax:541-275-9940
Practice Address - Street 1:3575 DONALD ST STE 240
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4759
Practice Address - Country:US
Practice Address - Phone:541-321-0788
Practice Address - Fax:541-275-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053700559OtherINDIVIDUAL NPI
OR500757076Medicaid