Provider Demographics
NPI:1891686119
Name:PHOENIX RISING NEVADA
Entity type:Organization
Organization Name:PHOENIX RISING NEVADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MANCEFIELD
Authorized Official - Last Name:HIGH
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:702-203-0743
Mailing Address - Street 1:5880 BOULDER FALLS ST APT 2033
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4962
Mailing Address - Country:US
Mailing Address - Phone:702-203-0743
Mailing Address - Fax:
Practice Address - Street 1:5880 BOULDER FALLS ST APT 2033
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4962
Practice Address - Country:US
Practice Address - Phone:702-203-0743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty