Healthcare Provider Details

I. General information

NPI: 1639708928
Provider Name (Legal Business Name): ROBERT JOSEPH PHILLIPS JR. BA, BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 KING ST
DENVER CO
80219-1326
US

IV. Provider business mailing address

325 KING ST
DENVER CO
80219-1326
US

V. Phone/Fax

Practice location:
  • Phone: 303-225-4100
  • Fax:
Mailing address:
  • Phone: 303-225-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNLC.0110856
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: