Provider Demographics
NPI:1942722079
Name:PHOENIX PSYCHOLOGY SERVICES, PLLC
Entity Type:Organization
Organization Name:PHOENIX PSYCHOLOGY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:507-261-2981
Mailing Address - Street 1:519 SOUTH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EYOTA
Mailing Address - State:MN
Mailing Address - Zip Code:55934-2918
Mailing Address - Country:US
Mailing Address - Phone:507-261-2981
Mailing Address - Fax:
Practice Address - Street 1:423 3RD AVE SE STE 201
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4897
Practice Address - Country:US
Practice Address - Phone:507-261-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health