| Rising Phoenix Wellness Center, Llc | |
|
22 Front St Ste F Coupeville WA 98239-3443 | |
| (360) 672-8303 | |
| Not Available |
| Full Name | Rising Phoenix Wellness Center, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 22 Front St Ste F, Coupeville, Washington |
| Authorized Official Name and Position | Jennifer Ayers (LICSW) |
| Authorized Official Contact | 3125026433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rising Phoenix Wellness Center, Llc 22 Front St Ste F Coupeville WA 98239-3443 Ph: (360) 672-8303 | Rising Phoenix Wellness Center, Llc 22 Front St Ste F Coupeville WA 98239-3443 Ph: (360) 672-8303 |
| NPI Number | 1992261853 |
|---|---|
| Provider Enumeration Date | 02/15/2019 |
| Last Update Date | 07/25/2019 |
| Medicare PECOS PAC ID | 1557601051 |
|---|---|
| Medicare Enrollment ID | O20190320000993 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992261853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jennifer Ayers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124319090 PECOS PAC ID: 0042550543 Enrollment ID: I20190626002745 |
| Provider Name | Gregory Carl Mabry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477851475 PECOS PAC ID: 1658758289 Enrollment ID: I20220519001551 |
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