Provider Demographics
NPI:1437635661
Name:PHOENIX PROFESSIONAL ADVISORS LLC
Entity Type:Organization
Organization Name:PHOENIX PROFESSIONAL ADVISORS LLC
Other - Org Name:KRATOS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:866-933-0999
Mailing Address - Street 1:8939 TURNSTONE HAVEN PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-0826
Mailing Address - Country:US
Mailing Address - Phone:813-325-2610
Mailing Address - Fax:
Practice Address - Street 1:10022 WATER WORKS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5301
Practice Address - Country:US
Practice Address - Phone:866-933-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty