MEDICARE: MRS. STEPHANIE JOY PHILLIPS M.ED., P.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	E0007885	OH
2	101YP2500X	Professional Counselor	KY-0104	KY

General Provider Information

NPI Number	:	1629158001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE JOY PHILLIPS M.ED., P.C.C.

Provider Business Mailing Address
First Line	:	26 E HOLLISTER ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-1704
Country	:	US
Telephone Number	:	513-621-5001
Fax Number	:	513-621-5008

Provider Business Practice Location Address
First Line	:	26 E HOLLISTER ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-1704
Country	:	US
Telephone Number	:	513-621-5001
Fax Number	:	513-621-5008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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