Provider Demographics
NPI:1821973066
Name:PHOENIX MENTAL HEALTH
Entity type:Organization
Organization Name:PHOENIX MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:608-289-6436
Mailing Address - Street 1:2905 RED WOLF TRL
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNDS
Mailing Address - State:WI
Mailing Address - Zip Code:53517-9717
Mailing Address - Country:US
Mailing Address - Phone:608-289-6436
Mailing Address - Fax:
Practice Address - Street 1:2905 RED WOLF TRL
Practice Address - Street 2:
Practice Address - City:BLUE MOUNDS
Practice Address - State:WI
Practice Address - Zip Code:53517-9717
Practice Address - Country:US
Practice Address - Phone:608-289-6436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty