Organization
SURVIVORS CIRCLE
Active
Other names
Phylla House Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT H MARSHALL JR. (CEO)
(708) 548-9209
Entity
Organization
Contact information
Practice address
1332 GREENFIELD AVE, WAUKEGAN, IL 60085-7813
(708) 548-9209
Mailing address
PO BOX 973, WAUKEGAN, IL 60079-0973
(708) 548-9209
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
103TR0400X
Rehabilitation Psychologist
—
—
104100000X
Social Worker
—
—
163WD0400X
Diabetes Educator Registered Nurse
—
—
251K00000X
Public Health or Welfare Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
—
261QP2400X
Prison Health Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
374K00000X
Religious Nonmedical Practitioner
—
—
Other
Enumeration date
03/01/2024
Last updated
06/17/2024
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