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General NPI Number Information
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NPI Number | 1346736204
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Entity Type | Organization
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Legal Business Name | PHOENIX FAMILY CENTER, LLC
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 452 N MCLEAN BLVD STE 100
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City | ELGIN
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State | IL
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Zip | 60123-3273
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Country | US
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Telephone | 847-334-8689
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Fax |
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Provider Business Mailing Address
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Address Line | 452 N MCLEAN BLVD STE 100
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City | ELGIN
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State | IL
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Zip | 60123-3273
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Country | US
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Telephone | 224-535-9555
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/THERAPIST
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Name | MICHELLE POTTER
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Credential |
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Telephone | 224-535-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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