Provider Demographics
NPI:1588158216
Name:PHOENIX COUNSELING & WELLNESS, PLC
Entity type:Organization
Organization Name:PHOENIX COUNSELING & WELLNESS, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LASANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCMHC, LADC
Authorized Official - Phone:802-353-3377
Mailing Address - Street 1:PO BOX 6758
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05702-6758
Mailing Address - Country:US
Mailing Address - Phone:802-772-4675
Mailing Address - Fax:802-610-1060
Practice Address - Street 1:198 N MAIN ST STE C-5
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-772-4675
Practice Address - Fax:802-610-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-16
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT06.80047526101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017232Medicaid