Phoenix Rising Professional Counseling, PC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401010792 Issued in MI

Legal business name

PHOENIX RISING PROFESSIONAL COUNSELING, PC

Practice address

302 West Michigan Avenue
Paw Paw, MI 49079-0026

Phone

(269) 998-9696

Fax

(269) 415-0284

NPI assigned

Apr 21, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Todd Christopher Day, MA, LLPC, NCC

Title

Director

Phone

(269) 998-9696

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271808000000",
    "number": "1447577101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790026",
            "telephone_number": "269-998-9696",
            "fax_number": "269-415-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 WEST MICHIGAN AVENUE",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490790026",
            "telephone_number": "269-998-9696",
            "fax_number": "269-415-0284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RISING PROFESSIONAL COUNSELING, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-21",
        "last_updated": "2010-04-21",
        "status": "A",
        "authorized_official_last_name": "DAY",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "269-998-9696",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, LLPC, NCC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6401010792",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401010792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1700049061",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Paw Paw, MI
• Providers in Paw Paw, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; 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.