Phoenix Rising Llc | |
N7640 County Road Wh Ste 200 Fond Du Lac WI 54937-7832 | |
(920) 933-3736 | |
Not Available |
Full Name | Phoenix Rising Llc |
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Speciality | Counselor - Professional |
Location | N7640 County Road Wh Ste 200, Fond Du Lac, Wisconsin |
Authorized Official Name and Position | Chrystal Stephany (OWNER) |
Authorized Official Contact | 9202514214 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Phoenix Rising Llc N7640 County Road Wh Ste 200 Fond Du Lac WI 54937-7832 Ph: (920) 933-3736 | Phoenix Rising Llc N7640 County Road Wh Ste 200 Fond Du Lac WI 54937-7832 Ph: (920) 933-3736 |
NPI Number | 1356794788 |
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Provider Enumeration Date | 07/20/2016 |
Last Update Date | 04/07/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356794788 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 6151-125 (Wisconsin) | Primary |
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