Provider Demographics
NPI:1326428814
Name:FENIX COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:FENIX COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRISTOBAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-788-6553
Mailing Address - Street 1:8201 PETERS RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3265
Mailing Address - Country:US
Mailing Address - Phone:954-916-2618
Mailing Address - Fax:
Practice Address - Street 1:8201 PETERS RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3265
Practice Address - Country:US
Practice Address - Phone:954-916-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7884251S00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1265452627Medicaid