Provider Demographics
NPI:1134830268
Name:T&T RISING PHOENIX LLC
Entity type:Organization
Organization Name:T&T RISING PHOENIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-426-4855
Mailing Address - Street 1:1103 OLD TOWN LN
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4353
Mailing Address - Country:US
Mailing Address - Phone:307-426-4855
Mailing Address - Fax:307-426-4865
Practice Address - Street 1:1103 OLD TOWN LN
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4353
Practice Address - Country:US
Practice Address - Phone:307-426-4855
Practice Address - Fax:307-426-4865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty