Provider Demographics
NPI:1952663411
Name:PHOENIX COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:PHOENIX COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, ART
Authorized Official - Phone:936-697-9034
Mailing Address - Street 1:804 FIELDSTONE PL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6873
Mailing Address - Country:US
Mailing Address - Phone:512-560-8920
Mailing Address - Fax:
Practice Address - Street 1:1004 W 31ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2002
Practice Address - Country:US
Practice Address - Phone:936-697-9034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63300251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health