Provider Demographics
NPI:1831200575
Name:PHOENIX MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:PHOENIX MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-941-1113
Mailing Address - Street 1:444 STILLWATER AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3500
Mailing Address - Country:US
Mailing Address - Phone:207-941-1113
Mailing Address - Fax:207-941-1134
Practice Address - Street 1:444 STILLWATER AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3500
Practice Address - Country:US
Practice Address - Phone:207-941-1113
Practice Address - Fax:207-941-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME492121251K00000X
ME468197251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare