Healthcare Provider Details

I. General information

NPI: 1134441165
Provider Name (Legal Business Name): JUDI A PHILLIPS MS, LMHC, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 E US HIGHWAY 36
AVON IN
46123-8923
US

IV. Provider business mailing address

6655 E US HIGHWAY 36
AVON IN
46123-8923
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-3330
  • Fax: 317-272-0807
Mailing address:
  • Phone: 317-272-3330
  • Fax: 317-272-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000491A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2555
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: