The Phoenix Clinic Nfp
Clinic/Center, Mental Health (Including Community Mental Health Center) in Chicago, IL. Organization (NPI-2).
NPI number1316632672
StatusActive
Last updated in NPPESApr 11, 2023
Details
- NPI
- 1316632672
- Entity type
- Organization (NPI-2)
- Legal business name
- The Phoenix Clinic Nfp
- Organization subpart
- No
- Enumeration date
- Apr 11, 2023
- Certification date
- Apr 11, 2023
- Last updated
- Apr 11, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Other names
- Phoenix Clinic Chicago (Doing Business As)
Practice location
1136 S Delano Ct W Ste B201Chicago, IL 60605-3734
Phone 773-431-7397
Mailing address
2436 W Cullom AveChicago, IL 60618-1604
Phone 773-431-7397
Authorized official
Taylor Ariel Pettway
Executive Director
7734317397
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