Healthcare Provider Details

I. General information

NPI: 1922747831
Provider Name (Legal Business Name): DUSTIN B PHILLIPS M.S., LCADC, CAIMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SCARLET DR
CORBIN KY
40701-8070
US

IV. Provider business mailing address

26 SCARLET DR
CORBIN KY
40701-8070
US

V. Phone/Fax

Practice location:
  • Phone: 606-595-3218
  • Fax: 606-215-8372
Mailing address:
  • Phone: 606-595-3218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number290480
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number290480
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: