Phoenix Behavioral Health Center, PLLC

Primary specialty

Health PsychologistTaxonomy code 103TH0004X

Legal business name

PHOENIX BEHAVIORAL HEALTH CENTER, PLLC

Practice address

2112 Bienville Blvd Ste K
Ocean Springs, MS 39564-3067

Phone

(228) 819-2171

Fax

(228) 205-4986

NPI assigned

Sep 24, 2019

Last updated

Jun 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kathryn Kim Waggoner, PSYD, ABPPNPI 1316188121

Title

Ceo

Phone

(228) 819-2171

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Suzanne Marie Ganschow, LPC, CAADC, BC-TMH

  • Counselor
  • Ocean Springs, MS
  • NPI 1073547238
  Medicare reassignment Care Compare group
• Kathryn Kim Waggoner, PSY.D., ABPP

  • Health Psychologist
  • Ocean Springs, MS
  • NPI 1316188121
  Medicare reassignment Authorized official
• Dewey Dewayne Watkins, MS, LPC

  • Professional Counselor
  • Pascagoula, MS
  • NPI 1356443121
  Medicare reassignment Care Compare group
• Amy E Wilkinson, M.ED., LPC

  • Professional Counselor
  • Ocean Springs, MS
  • NPI 1235256306
  Medicare reassignment Care Compare group
• Rachel A Raley, LMSW

  • Social Worker
  • Ocean Springs, MS
  • NPI 1952791055
  NPD
• Erin Beihl

  • Counselor
  • Ocean Springs, MS
  • NPI 1740924323
  NPD (past)
• Heather Lundy

  • Mental Health Counselor
  • Biloxi, MS
  • NPI 1932953510
  NPD (past)

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

{
    "created_epoch": "1569283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1093366775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 BIENVILLE BLVD STE K",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395643067",
            "telephone_number": "228-819-2171",
            "fax_number": "833-779-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 BIENVILLE BLVD STE K",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395643067",
            "telephone_number": "228-819-2171",
            "fax_number": "228-205-4986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX BEHAVIORAL HEALTH CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-24",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-819-2171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, ABPP"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Alyssa Pettis
• Mai Pham
• James Terence Phelan, DPM
• Stephanie Fay Phelan, D.P.M.
• Aubrey Phillips
• Physical Therapy Center of Ocean Springs, LLC (PT Solutions)
• Picking Up Loose Ends LLC
• Faith Piddock
• Peter W Pinto, CRNA
• Muzaffar Piracha, MD

• Health Psychologist in Ocean Springs, MS
• Providers in Ocean Springs, MS by specialty
• Health Psychologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.