Provider Demographics
NPI:1124902960
Name:PHOENIXRISEN COUNSELING, LLC
Entity type:Organization
Organization Name:PHOENIXRISEN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:RITTMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-201-1919
Mailing Address - Street 1:16315 ICE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2323
Mailing Address - Country:US
Mailing Address - Phone:612-201-1919
Mailing Address - Fax:
Practice Address - Street 1:6640 SHADY OAK RD STE 451
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7834
Practice Address - Country:US
Practice Address - Phone:612-201-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health