| Rising Phoenix Counseling Llc | |
| 
					9205 Oh 43 Streetsboro OH 44241  | |
| (734) 625-9260 | |
| Not Available | 
| Full Name | Rising Phoenix Counseling Llc | 
|---|---|
| Speciality | Counselor | 
| Location | 9205 Oh 43, Streetsboro, Ohio | 
| Authorized Official Name and Position | Kelly Lucas (OWNER/THERAPIST) | 
| Authorized Official Contact | 3305778281 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Rising Phoenix Counseling Llc 9374 State Route 14 # 1007 Streetsboro OH 44241-5224 Ph: () -  | Rising Phoenix Counseling Llc 9205 Oh 43 Streetsboro OH 44241 Ph: (734) 625-9260  | 
| NPI Number | 1710638721 | 
|---|---|
| Provider Enumeration Date | 01/11/2022 | 
| Last Update Date | 11/20/2024 | 
| Certification Date | 11/19/2024 | 
| Medicare PECOS PAC ID | 5092159079 | 
|---|---|
| Medicare Enrollment ID | O20240217000426 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1710638721 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary | 
| Provider Name | Kelly Lucas | 
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist | 
| Provider Identifiers | NPI Number: 1952837650 PECOS PAC ID: 6305281353 Enrollment ID: I20240229000849  | 
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