Provider Demographics
NPI:1205087962
Name:PHOENIX RISING COUNSELING, PC
Entity type:Organization
Organization Name:PHOENIX RISING COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-587-6288
Mailing Address - Street 1:PO BOX 2444
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-2444
Mailing Address - Country:US
Mailing Address - Phone:307-587-6288
Mailing Address - Fax:
Practice Address - Street 1:1001 14TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3745
Practice Address - Country:US
Practice Address - Phone:307-587-6288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-392251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health