| Phoenix Behavioral Health Services, Llc | |
|
3120 Memorial Dr Two Rivers WI 54241-3229 | |
| (920) 657-1780 | |
| (920) 657-1784 |
| Full Name | Phoenix Behavioral Health Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3120 Memorial Dr, Two Rivers, Wisconsin |
| Authorized Official Name and Position | Todd C Eiden (PSYCHOLOGIST) |
| Authorized Official Contact | 9206571780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Behavioral Health Services, Llc 3120 Memorial Dr Two Rivers WI 54241-3229 Ph: (920) 657-1780 | Phoenix Behavioral Health Services, Llc 3120 Memorial Dr Two Rivers WI 54241-3229 Ph: (920) 657-1780 |
| NPI Number | 1871514778 |
|---|---|
| Provider Enumeration Date | 07/23/2006 |
| Last Update Date | 02/22/2022 |
| Certification Date | 02/22/2022 |
| Medicare PECOS PAC ID | 1456441153 |
|---|---|
| Medicare Enrollment ID | O20071219000121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871514778 | NPI | - | NPPES |
| 42226300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Monique L Gore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568452803 PECOS PAC ID: 1355353301 Enrollment ID: I20060613000059 |
| Provider Name | Todd C Eiden |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033142518 PECOS PAC ID: 9335239037 Enrollment ID: I20121107000487 |
| Provider Name | Rene P Perales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881071637 PECOS PAC ID: 6507288388 Enrollment ID: I20200624001772 |
| Provider Name | Tyler R Brown |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467129890 PECOS PAC ID: 1759776487 Enrollment ID: I20220316001863 |
Safe Harbor Counseling And Wellness Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2848 Memorial Dr, Two Rivers, WI 54241 Phone: 920-553-1034 Fax: 920-553-1033 | |
Day By Day, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 117b Gardner St, Two Rivers, WI 54241 Phone: 920-629-0683 |