Healthcare Provider Details

I. General information

NPI: 1629991062
Provider Name (Legal Business Name): MARK EVAN PHILLIPS JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 TEPEE DR
HARKER HEIGHTS TX
76548-7413
US

IV. Provider business mailing address

13140 COIT RD STE 200
DALLAS TX
75240-5740
US

V. Phone/Fax

Practice location:
  • Phone: 254-371-0906
  • Fax:
Mailing address:
  • Phone: 469-480-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92843
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: