Healthcare Provider Details

I. General information

NPI: 1942738216
Provider Name (Legal Business Name): PHILIP HARRIS LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RIDGE MILL DRIVE
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

3645 RIDGE MILL DRIVE
HILLIARD OH
43026-7752
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax: 614-457-7896
Mailing address:
  • Phone: 614-457-7876
  • Fax: 614-457-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1700440
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberI.2203470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: