Provider Demographics
NPI:1669180493
Name:RISING PHOENIX MENTAL HEALTH, PLLC
Entity type:Organization
Organization Name:RISING PHOENIX MENTAL HEALTH, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRABHDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-491-6846
Mailing Address - Street 1:745 MCCLINTOCK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0863
Mailing Address - Country:US
Mailing Address - Phone:630-491-6846
Mailing Address - Fax:
Practice Address - Street 1:745 MCCLINTOCK DR STE 100
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-0863
Practice Address - Country:US
Practice Address - Phone:630-491-6846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty