Healthcare Provider Details

I. General information

NPI: 1346736204
Provider Name (Legal Business Name): PHOENIX FAMILY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 N MCLEAN BLVD STE 100
ELGIN IL
60123-3273
US

IV. Provider business mailing address

452 N MCLEAN BLVD STE 100
ELGIN IL
60123-3273
US

V. Phone/Fax

Practice location:
  • Phone: 847-334-8689
  • Fax:
Mailing address:
  • Phone: 224-535-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE POTTER
Title or Position: CO-OWNER/THERAPIST
Credential:
Phone: 224-535-9555