Phoenix Behavioral Health Services, LLC

Primary specialty

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

Legal business name

PHOENIX BEHAVIORAL HEALTH SERVICES, LLC

Practice address

3120 Memorial Dr
Two Rivers, WI 54241-3229

Phone

(920) 657-1780

Fax

(920) 657-1784

NPI assigned

Jul 23, 2006

Last updated

Feb 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Todd C Eiden, PHDNPI 1033142518

Title

Psychologist

Phone

(920) 657-1780

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 31

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.

• Todd C Eiden, PHD

  • Psychologist
  • Two Rivers, WI
  • NPI 1033142518
  Medicare reassignment Care Compare group NPD Authorized official
• Wayne K Edmonds, MS, LPC

  • Professional Counselor
  • Two Rivers, WI
  • NPI 1841407640
  Medicare reassignment Care Compare group NPD
• N John Laliberte, LPC, CSAC

  • Professional Counselor
  • Two Rivers, WI
  • NPI 1881600039
  Medicare reassignment Care Compare group NPD
• Jodi Ann Mathys, MSE, LPC

  • Professional Counselor
  • Green Bay, WI
  • NPI 1942386172
  Medicare reassignment Care Compare group NPD
• Tyler Robert Brown, PHD

  • Psychologist
  • Oshkosh, WI
  • NPI 1467129890
  Medicare reassignment NPD
• Monique L Gore, LCSW

  • Clinical Social Worker
  • Green Bay, WI
  • NPI 1568452803
  Medicare reassignment NPD
• Stephanie Larson

  • Professional Counselor
  • Two Rivers, WI
  • NPI 1013482264
  Medicare reassignment NPD
• Karrie May Kudrna Behrent, LPC

  • Professional Counselor
  • Two Rivers, WI
  • NPI 1629617667
  Care Compare group NPD
• Brianna Jean Bohm

  • Professional Counselor
  • Two Rivers, WI
  • NPI 1689417610
  NPD
• Melissa E Charles, APSW

  • Clinical Social Worker
  • Two Rivers, WI
  • NPI 1689569147
  NPD
• Jennifer Emnott, MA BCBA

  • Behavior Analyst
  • Two Rivers, WI
  • NPI 1922481027
  NPD
• Amber Marie Greene

  • Behavior Analyst
  • Two Rivers, WI
  • NPI 1902447121
  NPD

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

{
    "created_epoch": "1153612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1871514778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413229",
            "telephone_number": "920-657-1780",
            "fax_number": "920-657-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 MEMORIAL DR",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542413229",
            "telephone_number": "920-657-1780",
            "fax_number": "920-657-1784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX BEHAVIORAL HEALTH SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-23",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "EIDEN",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "920-657-1780",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42226300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neil Bain Patterson, DO
• Laura Peck
• Michelle K Petersen, NP
• Katelyn Peterson, D.P.T.
• Pharmacy Solutions Inc
• Physiotherapy Associates Inc
• Allison Pierce, LAT
• Jodi Lynn Platner, M.S. BCBA
• Ada Popovic, BCBA, LBA
• Charles D Pratt, MD

• Mental Health Clinic/Center (Including Community Mental Health Center) in Two Rivers, WI
• Providers in Two Rivers, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; 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.