Provider Demographics
NPI:1659962728
Name:PHOENIX BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:PHOENIX BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC CADC
Authorized Official - Phone:508-623-3931
Mailing Address - Street 1:2490 MAPLE SWAMP ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764
Mailing Address - Country:US
Mailing Address - Phone:508-685-5436
Mailing Address - Fax:
Practice Address - Street 1:31 PINE STREET, SUITE 207
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056
Practice Address - Country:US
Practice Address - Phone:508-623-3931
Practice Address - Fax:508-623-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health