Provider Demographics
NPI:1043071897
Name:PRIMROSE FAMILY THERAPY PLLC
Entity Type:Organization
Organization Name:PRIMROSE FAMILY THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHEYENNE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-822-8668
Mailing Address - Street 1:465 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4488
Mailing Address - Country:US
Mailing Address - Phone:815-822-8668
Mailing Address - Fax:
Practice Address - Street 1:465 PARK ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4488
Practice Address - Country:US
Practice Address - Phone:815-822-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty