| Phoenix Mental Health, P.l.c. | |
|
1911 Nicollet Ave # 210 Minneapolis MN 55403-3747 | |
| (612) 501-6807 | |
| (866) 591-9475 |
| Full Name | Phoenix Mental Health, P.l.c. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1911 Nicollet Ave # 210, Minneapolis, Minnesota |
| Authorized Official Name and Position | Jeffrey Shea Jones (PRESIDENT) |
| Authorized Official Contact | 6125016807 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Mental Health, P.l.c. 1911 Nicollet Ave # 210 Minneapolis MN 55403-3747 Ph: (612) 501-6807 | Phoenix Mental Health, P.l.c. 1911 Nicollet Ave # 210 Minneapolis MN 55403-3747 Ph: (612) 501-6807 |
| NPI Number | 1831329564 |
|---|---|
| Provider Enumeration Date | 07/15/2009 |
| Last Update Date | 07/15/2022 |
| Medicare PECOS PAC ID | 6608921663 |
|---|---|
| Medicare Enrollment ID | O20090827000489 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831329564 | NPI | - | NPPES |
| 1831329564 | Medicaid | MN |
| Provider Name | Jeffrey S Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033343637 PECOS PAC ID: 7517012560 Enrollment ID: I20090827000480 |
| Provider Name | Kailey M Everett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447830898 PECOS PAC ID: 4385047778 Enrollment ID: I20210722001775 |
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