# RISING PHOENIX COUNSELING LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710638721
- **Authorized official:** KELLY LUCAS IMFT (OWNER/THERAPIST)
- **Authorized official phone:** (330) 577-8281

## Contact information

- **Practice address:** 9205 OH 43, STREETSBORO, OH 44241
- **Practice address phone:** (734) 625-9260
- **Mailing address:** 9374 STATE ROUTE 14 \# 1007, STREETSBORO, OH 44241-5224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | Yes |
| 101YM0800X | Mental Health Counselor | — | — | Yes |

## Other

- **Enumeration date:** 01/11/2022
- **Last updated:** 11/20/2024