Organization · NPI-2

A Phoenix Rising, LLC

Clinic/Center, Mental Health (Including Community Mental Health Center) · Colorado Springs, CO

NPI number1033736699

StatusActive

Last updated in NPPESApr 16, 2025

Details

NPI: 1033736699
Entity type: Organization (NPI-2)
Legal business name: A Phoenix Rising, LLC
Organization subpart: No
Enumeration date: Jun 30, 2020
Certification date: Apr 16, 2025
Last updated: Apr 16, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–	Yes
101YM0800X	Counselor, Mental Health	–	–
261QM0850X	Clinic/Center, Adult Mental Health	–	–
261QM0855X	Clinic/Center, Adolescent and Children Mental Health	–	–

Other names

A Phoenix Rising, LLC (Doing Business As)

Practice location

308 W Fillmore St Ste 201
Colorado Springs, CO 80907-6000

Phone 719-439-6785

Mailing address

308 W Fillmore St Ste 201
Colorado Springs, CO 80907-6000

Phone 719-439-6785

Authorized official

Xander John Burgess
Owner
7194396785

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