| Phoenix Counseling And Wellness, Llc | |
|
35104 Euclid Ave Ste 306 Willoughby OH 44094-4566 | |
| (440) 571-5009 | |
| (440) 571-4850 |
| Full Name | Phoenix Counseling And Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 35104 Euclid Ave Ste 306, Willoughby, Ohio |
| Authorized Official Name and Position | Jacqueline Nashelle Lockett (CLINICAL THERAPIST/OWNER) |
| Authorized Official Contact | 4405715009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Counseling And Wellness, Llc 35104 Euclid Ave Ste 306 Willoughby OH 44094-4566 Ph: (440) 571-5009 | Phoenix Counseling And Wellness, Llc 35104 Euclid Ave Ste 306 Willoughby OH 44094-4566 Ph: (440) 571-5009 |
| NPI Number | 1154932473 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 10/27/2022 |
| Certification Date | 10/27/2022 |
| Medicare PECOS PAC ID | 4587060397 |
|---|---|
| Medicare Enrollment ID | O20210902001247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154932473 | NPI | - | NPPES |
| 1497255343 | Medicaid | OH |
| Provider Name | Jacqueline N Lockett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497255343 PECOS PAC ID: 8123448578 Enrollment ID: I20210902001452 |
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