Healthcare Provider Details

I. General information

NPI: 1316764731
Provider Name (Legal Business Name): EMOTIONAL HEALTH AND BEHAVIORAL CONSULTING/THE PHOENIX/PHOENIX BX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7938 S KENWOOD AVE
CHICAGO IL
60619-3411
US

IV. Provider business mailing address

7938 S KENWOOD AVE
CHICAGO IL
60619-3411
US

V. Phone/Fax

Practice location:
  • Phone: 312-874-0715
  • Fax:
Mailing address:
  • Phone: 312-874-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TAYLOR CHRISTIAN BROWN
Title or Position: OWNER AND CEO
Credential:
Phone: 312-874-0715