Phoenix Family Center, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PHOENIX FAMILY CENTER, LLC

Practice address

474 Summit St
Elgin, IL 60120

Phone

(847) 224-1256

NPI assigned

Apr 23, 2014

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michelle Potter, LCPCNPI 1053599753

Title

C0-Owner

Phone

(224) 535-9555

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

Phoenix Family Center LLC2 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.

• Phoenix Family Center, LLC

  • Adult Mental Health Clinic/Center
  • Elgin, IL
  • NPI 1346736204
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Katie L Hazek, LCSW

  • Clinical Social Worker
  • Elgin, IL
  • NPI 1043519275
  Medicare reassignment NPD
• Michelle Potter, LCPC

  • Professional Counselor
  • St Charles, IL
  • NPI 1053599753
  NPD Authorized official

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

{
    "created_epoch": "1398211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1467872820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 SUMMIT ST",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601203829",
            "telephone_number": "847-224-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 SUMMIT ST",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "60120",
            "telephone_number": "847-224-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX FAMILY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-23",
        "last_updated": "2022-07-21",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "C0-OWNER",
        "authorized_official_telephone_number": "224-535-9555",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "00",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PH Elgin, LLC (The Bridge Care Suites at Elgin)
• Sherry Pharr, CADC
• Deanna Phelan, DPT
• Deja Phillips, BSW
• Phoenix Family Center, LLC
• Physician Urgent Care of Illinois, Inc.
• Physicians Accountable Care Trust, LLC
• Jennifer Picciano, OT
• Katherine Piekarz, APN
• Daryl Pierce, MSW AND LSW

• Community/Behavioral Health Agency in Elgin, IL
• Providers in Elgin, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.