Healthcare Provider Details

I. General information

NPI: 1992416010
Provider Name (Legal Business Name): KRISTIN PHILLIPS, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 MAIN ST
YARMOUTH PORT MA
02675-1843
US

IV. Provider business mailing address

PO BOX 972
SOUTH YARMOUTH MA
02664-0972
US

V. Phone/Fax

Practice location:
  • Phone: 617-447-1528
  • Fax:
Mailing address:
  • Phone: 617-447-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN PHILLIPS
Title or Position: OWNER
Credential:
Phone: 309-506-5277