Provider Demographics
NPI:1104423185
Name:RISING PHOENIX COUNSELING SOLUTIONS
Entity type:Organization
Organization Name:RISING PHOENIX COUNSELING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:MCNABB
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MHPP
Authorized Official - Phone:406-249-6437
Mailing Address - Street 1:210 N HIGGINS AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4443
Mailing Address - Country:US
Mailing Address - Phone:406-249-6437
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGGINS AVE STE 222
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4443
Practice Address - Country:US
Practice Address - Phone:406-249-6437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-03
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty