Phoenix Peer Services LLC

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Legal business name

PHOENIX PEER SERVICES LLC

Practice address

7406 Route 487 Ste 1
Mildred, PA 18632-9031

Phone

(570) 485-8212

NPI assigned

Feb 19, 2024

Last updated

Feb 19, 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

Kathleen M Russell, CPS

Title

Cfo

Phone

(570) 485-8212

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1235994138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 512",
            "city": "WYSOX",
            "state": "PA",
            "postal_code": "188540512",
            "telephone_number": "570-485-8212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7406 ROUTE 487 STE 1",
            "city": "MILDRED",
            "state": "PA",
            "postal_code": "186329031",
            "telephone_number": "570-485-8212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PEER SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "570-485-8212",
        "authorized_official_credential": "CPS"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Concern-Professional Services for Children, Youth & Families
• Mildred Ambulance Association Inc

• Peer Specialist in Mildred, PA
• Providers in Mildred, PA by specialty
• Peer Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.