Provider Demographics
NPI:1467262485
Name:PHOENIX RISING COUNSELING, LLC
Entity type:Organization
Organization Name:PHOENIX RISING COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:662-296-1984
Mailing Address - Street 1:4488 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-6038
Mailing Address - Country:US
Mailing Address - Phone:662-296-1984
Mailing Address - Fax:
Practice Address - Street 1:499 GLOSTER CREEK VLG STE F6
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4631
Practice Address - Country:US
Practice Address - Phone:662-296-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health