Provider Demographics
NPI:1851966055
Name:PHOENIX RISING THERAPY LLC
Entity Type:Organization
Organization Name:PHOENIX RISING THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:C
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-397-5176
Mailing Address - Street 1:100 E MAIN ST STE 502
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5079
Mailing Address - Country:US
Mailing Address - Phone:410-397-5176
Mailing Address - Fax:855-975-2477
Practice Address - Street 1:100 E MAIN ST STE 502
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5079
Practice Address - Country:US
Practice Address - Phone:410-397-5176
Practice Address - Fax:855-975-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty