Provider Demographics
NPI:1659981140
Name:PHOENIX MENTAL HEALTH SOLUTIONS, LLC
Entity type:Organization
Organization Name:PHOENIX MENTAL HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEILINE
Authorized Official - Middle Name:MALEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MFT-A
Authorized Official - Phone:860-518-0937
Mailing Address - Street 1:85 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1248
Mailing Address - Country:US
Mailing Address - Phone:860-518-0937
Mailing Address - Fax:860-505-0075
Practice Address - Street 1:85 ADAMS ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1248
Practice Address - Country:US
Practice Address - Phone:860-518-0937
Practice Address - Fax:860-505-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-09
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2246OtherCT LICENSE