NPIMap

Organization Active NPI

Phoenix Counseling Center LLC

  • Professional Counselor
  • North Ridgeville, OH
National Provider Identifier
1801309141
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
E.1700389 Issued in OH
Legal business name
PHOENIX COUNSELING CENTER LLC
Practice address
33480 Liberty Pkwy
North Ridgeville, OH 44039-2670
Phone
(440) 732-5252
Fax
(440) 202-6252
NPI assigned
Nov 8, 2017
Last updated
Jun 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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

Authorized official

Name
Shaina A Duffy, M.A.,LPCCNPI 1760895445
Title
Licensed Professional Clinical Coun
Phone
(440) 732-5252

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
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X E.1700389 OH Primary

Addresses

Primary practice location

33480 Liberty Pkwy
North Ridgeville, OH 44039-2670

Mailing address

33480 Liberty Pkwy
North Ridgeville, OH 44039-2670
Phone (440) 732-5252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240412000370 OH Part B Supplier - Clinic/Group Practice 3577902451 Receives reassigned benefits from 15 practitioners
Practice locations: North Ridgeville, OH; Westlake, OH

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Counseling Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23550 Center Ridge Rd
Ste 102
Westlake, OH 44145
Phone (440) 732-5252

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1510099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1801309141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33480 LIBERTY PKWY",
            "city": "NORTH RIDGEVILLE",
            "state": "OH",
            "postal_code": "440392670",
            "telephone_number": "440-732-5252",
            "fax_number": "440-202-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33480 LIBERTY PKWY",
            "city": "NORTH RIDGEVILLE",
            "state": "OH",
            "postal_code": "440392670",
            "telephone_number": "440-732-5252",
            "fax_number": "440-202-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX COUNSELING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-08",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "DUFFY",
        "authorized_official_first_name": "SHAINA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "LICENSED PROFESSIONAL CLINICAL COUN",
        "authorized_official_telephone_number": "440-732-5252",
        "authorized_official_credential": "M.A.,LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.1700389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Ridgeville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.