Healthcare Provider Details

I. General information

NPI: 1003711003
Provider Name (Legal Business Name): PRAXIS CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11415 MAIN ST STE 103
ROSCOE IL
61073-9500
US

IV. Provider business mailing address

11415 MAIN ST STE 103
ROSCOE IL
61073-9500
US

V. Phone/Fax

Practice location:
  • Phone: 815-270-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIN LOGAN
Title or Position: OWNER/THERAPIST
Credential: MS, LCPC
Phone: 815-270-0005