Organization
PHOENIX GROUP MENTAL HEALTH SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN JEAN MARVIN LISW (PRESIDENT)
(515) 532-3338
Entity
Organization
Contact information
Practice address
103 2ND AVE NE, CLARION, IA 50525-1430
(515) 532-3338
(515) 532-3339
Mailing address
PO BOX 474, HUMBOLDT, IA 50548-0474
(515) 532-3338
(515) 532-3339
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316932833
—
IA
Enumeration date
09/12/2005
Last updated
06/25/2015
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