Provider Demographics
NPI:1851914816
Name:PHOENIX COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PHOENIX COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HOWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-363-2060
Mailing Address - Street 1:53 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-9111
Mailing Address - Country:US
Mailing Address - Phone:309-363-2060
Mailing Address - Fax:
Practice Address - Street 1:604 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6174
Practice Address - Country:US
Practice Address - Phone:309-363-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health