Healthcare Provider Details

I. General information

NPI: 1396901146
Provider Name (Legal Business Name): HENRY DANIEL PHILLIPS LCPC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E ROOSEVELT RD
WHEATON IL
60187-6850
US

IV. Provider business mailing address

1344 KELLER ST
ELBURN IL
60119-9091
US

V. Phone/Fax

Practice location:
  • Phone: 630-588-1201
  • Fax:
Mailing address:
  • Phone: 630-310-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.007396
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: