Provider Demographics
NPI:1447088687
Name:PHOENIX RISING COUNSELING AND CONSULTATION
Entity type:Organization
Organization Name:PHOENIX RISING COUNSELING AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER-BARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-873-8476
Mailing Address - Street 1:5316 PIKE CT S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2315
Mailing Address - Country:US
Mailing Address - Phone:503-873-8476
Mailing Address - Fax:
Practice Address - Street 1:5778 COMMERCIAL ST SE STE 101
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-3081
Practice Address - Country:US
Practice Address - Phone:503-873-8476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty