Green Phoenix Behavioral Health Services

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

GREEN PHOENIX BEHAVIORAL HEALTH SERVICES

Practice address

3154 Memorial Hwy Ste 100
Dallas, PA 18612-9203

Phone

(570) 855-9404

NPI assigned

Mar 5, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanda Leah Rodriguez Rogers, LPCNPI 1104606847

Title

Owner

Phone

(570) 855-9404

Specialties & licenses 1

Addresses

Other names 1

• Green Phoenix Doing business as

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amanda Leah Rodriguez Rogers

  • Professional Counselor
  • Hunlock Creek, PA
  • NPI 1104606847
  NPD Authorized official
• Miriam Inez Hartley, MSW/LCSW

  • Clinical Social Worker
  • Dallas, PA
  • NPI 1588948467

  Multi-Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1023875010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2182 STATE ROUTE 29 HWY",
            "city": "HUNLOCK CREEK",
            "state": "PA",
            "postal_code": "186214512",
            "telephone_number": "570-239-8052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3154 MEMORIAL HWY STE 100",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186129203",
            "telephone_number": "570-855-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN PHOENIX BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ ROGERS",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "LEAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-855-9404",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Green Phoenix",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Green Phoenix",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dennis C. Gold, PH.D.
• Anthony David Goodall, DPT
• Curtis L Goodwin, OD
• Jennifer Nicole Goresh, PHARMD
• Marie Colette Gray, PHD; NCP; LPC;FAAGFS
• Joan Elizabeth Greulick, MD
• Joseph Grzech
• Kathryn Olivia Gussman, M.D.
• David Hage, MSW, LCSW
• Phillip McKenzie Halliday

• Mental Health Clinic/Center (Including Community Mental Health Center) in Dallas, PA
• Providers in Dallas, PA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.