Provider Demographics
NPI:1245116110
Name:PHOENIX RISING BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:PHOENIX RISING BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:MHRTC
Authorized Official - Phone:207-313-1881
Mailing Address - Street 1:183 STATE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6432
Mailing Address - Country:US
Mailing Address - Phone:207-313-1881
Mailing Address - Fax:207-742-4231
Practice Address - Street 1:183 STATE ST APT 3
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6432
Practice Address - Country:US
Practice Address - Phone:207-313-1881
Practice Address - Fax:207-742-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care