Healthcare Provider Details

I. General information

NPI: 1295763282
Provider Name (Legal Business Name): RYAN PATRICK PHILLIPS MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PATEWOOD DR STE 160
GREENVILLE SC
29615-6809
US

IV. Provider business mailing address

30 PATEWOOD DR STE 160
GREENVILLE SC
29615-6809
US

V. Phone/Fax

Practice location:
  • Phone: 843-501-1099
  • Fax: 843-405-2040
Mailing address:
  • Phone: 843-501-1099
  • Fax: 843-405-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4044
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: