| Phoenix Rising Llc | |
|
N7640 County Road Wh Ste 200 Fond Du Lac WI 54937-7832 | |
| (920) 933-3736 | |
| Not Available |
| Full Name | Phoenix Rising Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | N7640 County Road Wh Ste 200, Fond Du Lac, Wisconsin |
| Authorized Official Name and Position | Chrystal Stephany (OWNER) |
| Authorized Official Contact | 9202514214 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Llc N7640 County Road Wh Ste 200 Fond Du Lac WI 54937-7832 Ph: (920) 933-3736 | Phoenix Rising Llc N7640 County Road Wh Ste 200 Fond Du Lac WI 54937-7832 Ph: (920) 933-3736 |
| NPI Number | 1356794788 |
|---|---|
| Provider Enumeration Date | 07/20/2016 |
| Last Update Date | 04/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356794788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 6151-125 (Wisconsin) | Primary |
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