| Phoenix Rising Wellness Center Of Corpus Christi, Pllc | |
|
6000 S Staples St Ste 406 Corpus Christi TX 78413-2952 | |
| (361) 739-1679 | |
| (361) 239-4286 |
| Full Name | Phoenix Rising Wellness Center Of Corpus Christi, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 6000 S Staples St Ste 406, Corpus Christi, Texas |
| Authorized Official Name and Position | James P Ikonomopoulos (OWNER) |
| Authorized Official Contact | 3614254684 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Wellness Center Of Corpus Christi, Pllc Po Box 181459 Corpus Christi TX 78480-1459 Ph: (361) 739-1679 | Phoenix Rising Wellness Center Of Corpus Christi, Pllc 6000 S Staples St Ste 406 Corpus Christi TX 78413-2952 Ph: (361) 739-1679 |
| NPI Number | 1659950343 |
|---|---|
| Provider Enumeration Date | 04/07/2021 |
| Last Update Date | 11/27/2023 |
| Certification Date | 11/27/2023 |
| Medicare PECOS PAC ID | 0547618845 |
|---|---|
| Medicare Enrollment ID | O20231128000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659950343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | James Peter Ikonomopoulos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477892081 PECOS PAC ID: 2365890662 Enrollment ID: I20231128000305 |
| Provider Name | Claudia Schmidt Ikonomopoulos |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699199828 PECOS PAC ID: 9234587122 Enrollment ID: I20231204001178 |
| Provider Name | Jaylen Avery Bowman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154029593 PECOS PAC ID: 7618325457 Enrollment ID: I20231204003724 |
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