Healthcare Provider Details

I. General information

NPI: 1982956298
Provider Name (Legal Business Name): JEREMY PHILLIPS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2012
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 FREEPORT RD
NATRONA HEIGHTS PA
15065-1651
US

IV. Provider business mailing address

2502 HIGH ST
NATRONA HTS PA
15065-2426
US

V. Phone/Fax

Practice location:
  • Phone: 724-757-6119
  • Fax: 724-409-6060
Mailing address:
  • Phone: 724-757-4454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006789
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: