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General NPI Number Information
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NPI Number | 1073401808
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Entity Type | Individual
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Provider Name | ELLIOT PHILLIPS MA
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Gender | Male
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 500 DAVIS ST STE 815
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City | EVANSTON
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State | IL
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Zip | 60201-4655
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Country | US
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Telephone | 312-640-7740
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Fax |
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Provider Business Mailing Address
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Address Line | 5013 N WOLCOTT AVE APT 3W
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City | CHICAGO
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State | IL
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Zip | 60640-2621
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Country | US
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Telephone | 917-459-3004
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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