Provider Demographics
NPI:1760029623
Name:PHOENIX RISING PSYCHOTHERAPY CENTER PLLC
Entity Type:Organization
Organization Name:PHOENIX RISING PSYCHOTHERAPY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:561-502-1500
Mailing Address - Street 1:4060 ROYAL PALM BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-9165
Mailing Address - Country:US
Mailing Address - Phone:561-502-1500
Mailing Address - Fax:
Practice Address - Street 1:816 W CANAL ST S
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2942
Practice Address - Country:US
Practice Address - Phone:561-502-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health