Provider Demographics
NPI:1336520352
Name:PHOENIX RISING COUNSELING AND PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:PHOENIX RISING COUNSELING AND PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-988-5620
Mailing Address - Street 1:5931 MIDDLEFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2865
Mailing Address - Country:US
Mailing Address - Phone:720-988-5620
Mailing Address - Fax:720-554-7983
Practice Address - Street 1:5931 MIDDLEFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2865
Practice Address - Country:US
Practice Address - Phone:720-988-5620
Practice Address - Fax:720-554-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000001401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68408536Medicaid