# MISTY MOUNTAIN PHOENIX RISING LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wendy Rozelle, M.A. MFT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235803636
- **Authorized official:** WENDY ROZELLE MA MFT (LMFT)
- **Authorized official phone:** (818) 602-3680

## Contact information

- **Practice address:** 23550 LYONS AVE., SUITE 211, NEWHALL, CA 91321-9132
- **Practice address phone:** (818) 602-3680
- **Practice address fax:** (661) 309-4677
- **Mailing address:** 22314 CANONES CIRCLE, SANTA CLARITA, CA 91350-2244
- **Mailing address phone:** (818) 602-3680
- **Mailing address fax:** (661) 309-4677

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 08/09/2021
- **Last updated:** 08/09/2021