PHOENIX BEHAVIORAL HEALTH CENTER, PLLC
NPI 1093366775
Psychologist - Health in Ocean Springs, MS

Q: What is Phoenix Behavioral Health Center, PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Health, with taxonomy code 103TH0004X.

Active since September 24, 2019

2112 BIENVILLE BLVD STE K, OCEAN SPRINGS, MS 39564(228) 819-2171(228) 205-4986 Get Directions Write a Review

NPPES record last updated: June 10, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 10, 2024, Aug 8, 2022, Feb 1, 2022 and 3 more (6 updates tracked since 2019).

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About Phoenix Behavioral Health Center, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHOENIX BEHAVIORAL HEALTH CENTER, PLLC (NPI 1093366775) is a healthcare organization registered as a health in Ocean Springs, Mississippi and active in the NPI registry since September 2019. The organization lists Kathryn Kim Waggoner, Ceo, as its authorized official.

NPPES Registry Identity

NPI1093366775

Entity TypeOrganization

Primary Taxonomy103TH0004X

Legal Business NamePHOENIX BEHAVIORAL HEALTH CENTER, PLLC

Location Address2112 BIENVILLE BLVD STE KOcean Springs, MS 39564-3067

Mailing Address2112 Bienville Blvd Ste KOcean Springs, MS 39564-3067 · (228) 819-2171 · Fax (833) 779-1879

Phone(228) 819-2171

Fax(228) 205-4986

Organization SubpartNo

Authorized OfficialKathryn Kim WaggonerCeo · (228) 819-2171

Enumeration DateSeptember 24, 2019

Last NPPES UpdateJune 10, 20246 updates tracked since enumeration

NPPES CertifiedJune 10, 2024

✔ NPI 1093366775 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyPsychologist · HealthBehavioral Health & Social Service Providers

Taxonomy Code103TH0004X

Definition

A psychologist who specializes in clinical health psychology that investigates and implements clinical services across diverse populations and settings to promote health and well-being and to prevent, treat, and manage illness and disability. Clinical health psychology sees health as the confluence of psychological, social, cultural, and biological factors and applies this understanding to professional activities including:

Also ListedCounselorTaxonomy 101Y00000X

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X

Also ListedCounselor · ProfessionalTaxonomy 101YP2500X

Also ListedPsychologistTaxonomy 103T00000X

Also ListedPsychologist · ClinicalTaxonomy 103TC0700X

2112 BIENVILLE BLVD STE K, Ocean Springs, MS 39564

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Phoenix Behavioral Health Center, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 4 clinicians reassign Medicare billing to Phoenix Behavioral Health Center, PLLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address. They are listed nearest first.

Clinicians, nearest first (4)

Suzanne Ganschow, LPC, CAADC, BC-TMH

Mental Health Counselor

NPI 1073547238

2112 BIENVILLE BLVD STE K
Ocean Springs, MS 39564

(228) 819-2171

✔ PECOS✔ Accepts MedicareSame address

Kathryn Waggoner, PSY.D., ABPP

Clinical Psychologist

NPI 1316188121

2112 BIENVILLE BLVD STE K
Ocean Springs, MS 39564

(228) 819-2171

✔ PECOSSame address

Amy Wilkinson, M.ED., LPC

Mental Health Counselor

NPI 1235256306

2112 BIENVILLE BLVD STE K
Ocean Springs, MS 39564

(228) 819-2171

✔ PECOS✔ Accepts MedicareSame address

Dewey Watkins, MS, LPC

Mental Health Counselor

NPI 1356443121

4502 LT EUGENE J MAJURE DR
Pascagoula, MS 39581

(228) 696-9224

✔ PECOS✔ Accepts Medicare19 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phoenix Behavioral Health Center, PLLC's NPI number?

The NPI number for Phoenix Behavioral Health Center, PLLC is 1093366775. It was assigned to this organization in the NPPES registry on September 24, 2019.

Where is Phoenix Behavioral Health Center, PLLC located?

Phoenix Behavioral Health Center, PLLC is located at 2112 Bienville Blvd Ste K, Ocean Springs, MS 39564. The listed phone number is (228) 819-2171.

What is Phoenix Behavioral Health Center, PLLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Health, with taxonomy code 103TH0004X.

Is Phoenix Behavioral Health Center, PLLC enrolled in Medicare?

Yes. Phoenix Behavioral Health Center, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Phoenix Behavioral Health Center, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Phoenix Behavioral Health Center, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Mental Health Counselor (3) and Clinical Psychologist (1). Of these, 3 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Phoenix Behavioral Health Center, PLLC accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter of Alabama and Ambetter of Tennessee and 1 other insurer list Phoenix Behavioral Health Center, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Phoenix Behavioral Health Center, PLLC was last updated on June 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.