Healthcare Provider Details

I. General information

NPI: 1629158001
Provider Name (Legal Business Name): STEPHANIE JOY PHILLIPS M.ED., P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 E HOLLISTER ST
CINCINNATI OH
45219-1704
US

IV. Provider business mailing address

26 E HOLLISTER ST
CINCINNATI OH
45219-1704
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-5001
  • Fax: 513-621-5008
Mailing address:
  • Phone: 513-621-5001
  • Fax: 513-621-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0007885
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberKY-0104
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: