| Phoenix Counseling Center Llc | |
|
33480 Liberty Pkwy North Ridgeville OH 44039-2670 | |
| (440) 732-5252 | |
| (440) 202-6252 |
| Full Name | Phoenix Counseling Center Llc |
|---|---|
| Speciality | Counselor |
| Location | 33480 Liberty Pkwy, North Ridgeville, Ohio |
| Authorized Official Name and Position | Shaina A Duffy (LICENSED PROFESSIONAL CLINICAL COUN) |
| Authorized Official Contact | 4407325252 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Counseling Center Llc 33480 Liberty Pkwy North Ridgeville OH 44039-2670 Ph: (440) 732-5252 | Phoenix Counseling Center Llc 33480 Liberty Pkwy North Ridgeville OH 44039-2670 Ph: (440) 732-5252 |
| NPI Number | 1801309141 |
|---|---|
| Provider Enumeration Date | 11/08/2017 |
| Last Update Date | 06/25/2019 |
| Medicare PECOS PAC ID | 3577902451 |
|---|---|
| Medicare Enrollment ID | O20240412000370 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801309141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | E.1700389 (Ohio) | Primary |
| Provider Name | Deanna Revels |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770126310 PECOS PAC ID: 5799135919 Enrollment ID: I20231229000446 |
| Provider Name | Emmett Drugan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891317798 PECOS PAC ID: 4486007309 Enrollment ID: I20240126003522 |
| Provider Name | Tracy C Doran |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578953576 PECOS PAC ID: 5496199135 Enrollment ID: I20240221001130 |
| Provider Name | Courtney L Hughes-ksenich |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396361317 PECOS PAC ID: 1850738352 Enrollment ID: I20240320000474 |
| Provider Name | Candace A Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629327101 PECOS PAC ID: 5890134753 Enrollment ID: I20240411004747 |
| Provider Name | Katherine T Krizman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699918011 PECOS PAC ID: 6709225667 Enrollment ID: I20240411004755 |
| Provider Name | Roseann D Harper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710003314 PECOS PAC ID: 1153760012 Enrollment ID: I20240411004765 |
| Provider Name | Tiel M Wilczynski |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225493067 PECOS PAC ID: 4880033745 Enrollment ID: I20240411004771 |
| Provider Name | Shaina Duffy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760895445 PECOS PAC ID: 0749629624 Enrollment ID: I20240412000738 |
| Provider Name | Heidi Booth |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1386396513 PECOS PAC ID: 8820437627 Enrollment ID: I20240412001411 |
| Provider Name | Ryan Crundwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427396522 PECOS PAC ID: 5092154641 Enrollment ID: I20240416003104 |
| Provider Name | Amy M Hall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588177554 PECOS PAC ID: 7517306012 Enrollment ID: I20240417000772 |
| Provider Name | Mariah Payne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1689223703 PECOS PAC ID: 6002255080 Enrollment ID: I20240424000612 |
| Provider Name | Christopher Roseman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982005419 PECOS PAC ID: 1153761853 Enrollment ID: I20240429001726 |
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Phoenix Counseling Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 33480 Liberty Pkwy, North Ridgeville, OH 44039 Phone: 440-732-5252 Fax: 440-271-2003 |