Healthcare Provider Details

I. General information

NPI: 1861970444
Provider Name (Legal Business Name): CHANTELL PHILLIPS LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2018
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 HEMSTOCK ST
LA CROSSE WI
54603-2350
US

IV. Provider business mailing address

933 TYLER ST
LA CROSSE WI
54601-5555
US

V. Phone/Fax

Practice location:
  • Phone: 608-406-2250
  • Fax: 608-406-2144
Mailing address:
  • Phone: 608-738-6635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16214-132
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6893-125
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6893-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: