Provider Demographics
NPI:1194872143
Name:PHOENIX COUNSELING, INC.
Entity type:Organization
Organization Name:PHOENIX COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:OJIEWULU
Authorized Official - Last Name:UCHEAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-556-1153
Mailing Address - Street 1:5120 WALNUT STREET, SUITE 11
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2471
Mailing Address - Country:US
Mailing Address - Phone:402-556-1153
Mailing Address - Fax:402-556-1153
Practice Address - Street 1:5120 WALNUT STREET, SUITE 11
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2471
Practice Address - Country:US
Practice Address - Phone:402-556-1153
Practice Address - Fax:402-556-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid