Provider Demographics
NPI:1134707854
Name:PHOENIX RISING INTERVENTION SERVICES INC
Entity type:Organization
Organization Name:PHOENIX RISING INTERVENTION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUBEA
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:636-295-6672
Mailing Address - Street 1:140 WESTBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-4453
Mailing Address - Country:US
Mailing Address - Phone:636-295-6672
Mailing Address - Fax:
Practice Address - Street 1:690 S LINCOLN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2808
Practice Address - Country:US
Practice Address - Phone:636-295-6672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty