Provider Demographics
NPI:1316764731
Name:EMOTIONAL HEALTH AND BEHAVIORAL CONSULTING/THE PHOENIX/PHOENIX BX
Entity type:Organization
Organization Name:EMOTIONAL HEALTH AND BEHAVIORAL CONSULTING/THE PHOENIX/PHOENIX BX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-874-0715
Mailing Address - Street 1:7938 S KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3411
Mailing Address - Country:US
Mailing Address - Phone:312-874-0715
Mailing Address - Fax:
Practice Address - Street 1:7938 S KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3411
Practice Address - Country:US
Practice Address - Phone:312-874-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care