NPIMap

Organization Active NPI

Phoenix Wellness Services LLC

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1720624802
Registry record updated Aug 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PHOENIX WELLNESS SERVICES LLC
Practice address
10 E North Ave Ste 10
Baltimore, MD 21202-4886
Phone
(240) 242-9302
Fax
(240) 308-8646
NPI assigned
Nov 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2023

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

Authorized official

Name
Thalia Yvette Bishop, PSYDNPI 1215573399
Title
Owner/Managing Member
Phone
(240) 522-9139

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
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

10 E North Ave Ste 10
Baltimore, MD 21202-4886

Mailing address

10 E North Ave Ste 10
Baltimore, MD 21202-4886
Phone (240) 242-9302

National Provider Directory

National Provider Directory

Locations

10 E North Ave
Ste 10
Baltimore, MD 21202
Phone (240) 242-9302

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692057600000",
    "number": "1720624802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 E NORTH AVE STE 10",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024886",
            "telephone_number": "240-242-9302",
            "fax_number": "240-308-8646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 E NORTH AVE STE 10",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024886",
            "telephone_number": "240-242-9302",
            "fax_number": "240-308-8646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX WELLNESS SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-22",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "THALIA",
        "authorized_official_middle_name": "YVETTE",
        "authorized_official_title_or_position": "OWNER/MANAGING MEMBER",
        "authorized_official_telephone_number": "240-522-9139",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; 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.