Provider Demographics
NPI:1457025801
Name:ASCENDING PHOENIX THERAPY LLC
Entity Type:Organization
Organization Name:ASCENDING PHOENIX THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VANMEERTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-724-0053
Mailing Address - Street 1:4250 MARTIN WAY E STE 105-297
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5317
Mailing Address - Country:US
Mailing Address - Phone:509-724-0053
Mailing Address - Fax:
Practice Address - Street 1:4250 MARTIN WAY E STE 105-297
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5317
Practice Address - Country:US
Practice Address - Phone:509-724-0053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty