Provider Demographics
NPI:1053721894
Name:PHOENIX COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:PHOENIX COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-797-7786
Mailing Address - Street 1:RR 6 BOX 5
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-9501
Mailing Address - Country:US
Mailing Address - Phone:918-797-7786
Mailing Address - Fax:918-696-8679
Practice Address - Street 1:RR 6 BOX 5
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-9501
Practice Address - Country:US
Practice Address - Phone:918-797-7786
Practice Address - Fax:918-696-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health