Provider Demographics
NPI:1447577101
Name:PHOENIX RISING PROFESSIONAL COUNSELING, PC
Entity Type:Organization
Organization Name:PHOENIX RISING PROFESSIONAL COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLPC, NCC
Authorized Official - Phone:269-998-9696
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0026
Mailing Address - Country:US
Mailing Address - Phone:269-998-9696
Mailing Address - Fax:269-415-0284
Practice Address - Street 1:302 WEST MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-0026
Practice Address - Country:US
Practice Address - Phone:269-998-9696
Practice Address - Fax:269-415-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010792101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700049061OtherNPI NUMBER