| Rising Phoenix Counseling Llc | |
|
830 Holborn Rd Streetsboro OH 44241-4315 | |
| (734) 625-9260 | |
| Not Available |
| Full Name | Rising Phoenix Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 830 Holborn Rd, 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 830 Holborn Rd Streetsboro OH 44241-4315 Ph: (734) 625-9260 |
| NPI Number | 1710638721 |
|---|---|
| Provider Enumeration Date | 01/11/2022 |
| Last Update Date | 02/27/2024 |
| Certification Date | 02/27/2024 |
| 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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