Healthcare Provider Details

I. General information

NPI: 1194682187
Provider Name (Legal Business Name): NEVIN PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E LIBERTY ST STE 202
WOOSTER OH
44691-5000
US

IV. Provider business mailing address

24100 CHAGRIN BLVD STE 330
BEACHWOOD OH
44122-5552
US

V. Phone/Fax

Practice location:
  • Phone: 330-439-0620
  • Fax:
Mailing address:
  • Phone: 800-642-4560
  • Fax: 216-245-6770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507369-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: