Phoenix Wellness Group, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PHOENIX WELLNESS GROUP, LLC

Practice address

1030 Shive LN
Bowling Green, KY 42103-8037

Phone

(270) 943-1851

NPI assigned

Jan 2, 2013

Organization subpart

No

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

Authorized official

Name

Jill K Duncan, LCSW

Title

Director of Clinical Services

Phone

(270) 943-1851

Specialties & licenses 1

Addresses

Practitioners 1

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

• Tamara Brucato, MSSW, LCSW, KPS

  • Clinical Social Worker
  • Bowling Green, KY
  • NPI 1770829293
  NPD (past)

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

{
    "created_epoch": "1357084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357084800000",
    "number": "1831435379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 INDUSTRIAL DR APT 610",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421014154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 SHIVE LN",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421038037",
            "telephone_number": "270-943-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX WELLNESS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-02",
        "last_updated": "2013-01-02",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "270-943-1851",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Phen, PHARMD
• James K Phillips Jr., MD
• Joshua Daniel Phillips, D.M.D.
• Phoenix Rehab Group, LLC
• Phoenix Rehab, LLC
• Physician Management Services PSC
• Physicians Rehab Solution LLC
• Debra Pickering, MS BCBA LBA
• Christina Pickett
• Angel Pierce, COTA

• Mental Health Clinic/Center (Including Community Mental Health Center) in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2013; 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.