NPIMap

Organization Active NPI

Phoenix Therapy Center, LLC

  • Social Worker
  • Bowman, ND
National Provider Identifier
1285344291
Registry record updated Nov 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Legal business name
PHOENIX THERAPY CENTER, LLC
Practice address
402 6TH Ave SW
Bowman, ND 58623-4506
Phone
(701) 206-0955
NPI assigned
Nov 30, 2022
Last updated
Nov 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2022

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

Authorized official

Name
Melissa A. Buchholz, LMSWNPI 1467842294
Title
Owner
Phone
(701) 523-3285

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X NU Primary

Addresses

Primary practice location

402 6TH Ave SW
Bowman, ND 58623-4506

Mailing address

602 1St St NW
Bowman, ND 58623-4461
Phone (701) 206-0955

Other identifiers 1

IdentifierTypeStateIssuer
1467842294MedicaidND

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL phoenixtherapycenter@gmail.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669766400000",
    "number": "1285344291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 1ST ST NW",
            "city": "BOWMAN",
            "state": "ND",
            "postal_code": "586234461",
            "telephone_number": "701-206-0955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 6TH AVE SW",
            "city": "BOWMAN",
            "state": "ND",
            "postal_code": "586234506",
            "telephone_number": "701-206-0955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX THERAPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-30",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A",
        "authorized_official_last_name": "BUCHHOLZ",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-523-3285",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467842294",
            "state": "ND"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "phoenixtherapycenter@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "402 6th Ave SW",
            "city": "Bowman",
            "state": "ND",
            "country_code": "US",
            "postal_code": "586234506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bowman, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2022; 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.