The Phoenix Clinic NFP

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

THE PHOENIX CLINIC NFP

Practice address

1136 S Delano CT W Ste B201
Chicago, IL 60605-3734

Phone

(773) 431-7397

NPI assigned

Apr 11, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Taylor Ariel Pettway, LMFTNPI 1922589639

Title

Executive Director

Phone

(773) 431-7397

Specialties & licenses 1

Addresses

Other names 1

• Phoenix Clinic Chicago Doing business as

Tax ID family

The Phoenix Clinic NFP2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Phoenix Clinic NFP

  • Adult Mental Health Clinic/Center
  • Chicago, IL
  • NPI 1811783079
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• The Phoenix Clinic NFP

  • Adult Mental Health Clinic/Center
  • Chicago, IL
  • NPI 1811783079
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taylor Ariel Pettway, MS

  • Marriage & Family Therapist
  • Chicago, IL
  • NPI 1922589639
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681171200000",
    "number": "1316632672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2436 W CULLOM AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606181604",
            "telephone_number": "773-431-7397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 S DELANO CT W STE B201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053734",
            "telephone_number": "773-431-7397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PHOENIX CLINIC NFP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-11",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "PETTWAY",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_middle_name": "ARIEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "773-431-7397",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Clinic Chicago",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Pain & Rehabilitation Clinic of Chicago
• The Pain Center
• The Pain Center of Illinois Inc.
• The People'S OT, PLLC
• The Personal Development Group, Inc
• The Phoenix Clinic NFP
• The Physical Therapy Academy
• The Pivot Nurse, Inc.
• The Place for Speech Therapy LLC
• The Power of Love and Communication Inc

• Mental Health Clinic/Center (Including Community Mental Health Center) in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.