Provider Demographics
NPI:1679997266
Name:PHOENIX BEHAVIORAL SERVICES, INC
Entity type:Organization
Organization Name:PHOENIX BEHAVIORAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MHS, CAADC, MAC
Authorized Official - Phone:708-926-2789
Mailing Address - Street 1:4649 147TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445
Mailing Address - Country:US
Mailing Address - Phone:708-926-2789
Mailing Address - Fax:708-926-2797
Practice Address - Street 1:4649 147TH STREET
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445
Practice Address - Country:US
Practice Address - Phone:708-926-2789
Practice Address - Fax:708-926-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA58510002A251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management