Healthcare Provider Details

I. General information

NPI: 1093708208
Provider Name (Legal Business Name): ROBERT J. DEAN PHILLIPS M.S.,L.C.P.C.,N.C.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 4TH ST
EFFINGHAM IL
62401-3032
US

IV. Provider business mailing address

1200 N 4TH ST
EFFINGHAM IL
62401-3032
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-7179
  • Fax:
Mailing address:
  • Phone: 217-347-7179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180005312
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39002212A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: