| Misty Mountain Phoenix Rising Llc | |
|
23550 Lyons Ave. Suite 211 Newhall CA 91321-9132 | |
| (818) 602-3680 | |
| (661) 309-4677 |
| Full Name | Misty Mountain Phoenix Rising Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 23550 Lyons Ave., Newhall, California |
| Authorized Official Name and Position | Wendy Rozelle (LMFT) |
| Authorized Official Contact | 8186023680 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Misty Mountain Phoenix Rising Llc 22314 Canones Circle Santa Clarita CA 91350-2244 Ph: (818) 602-3680 | Misty Mountain Phoenix Rising Llc 23550 Lyons Ave. Suite 211 Newhall CA 91321-9132 Ph: (818) 602-3680 |
| NPI Number | 1235803636 |
|---|---|
| Provider Enumeration Date | 08/09/2021 |
| Last Update Date | 08/09/2021 |
| Certification Date | 08/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235803636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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