Provider Demographics
NPI:1306298740
Name:PHOENIX COUNSELING
Entity type:Organization
Organization Name:PHOENIX COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CSAC
Authorized Official - Phone:715-296-3840
Mailing Address - Street 1:64 S 4TH ST
Mailing Address - Street 2:P.O. BOX 142
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-1503
Mailing Address - Country:US
Mailing Address - Phone:715-537-5610
Mailing Address - Fax:715-637-5749
Practice Address - Street 1:64 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1503
Practice Address - Country:US
Practice Address - Phone:715-537-5610
Practice Address - Fax:715-637-5749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITING MAINTENANCE SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-11
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15915-132324500000X
WI6013-125324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility