=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134019243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILLIPS COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2025
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1249 S MAIN ST STE 3
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-595-3218
-----------------------------------------------------
Fax | 606-215-8372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 SCARLET DR
-----------------------------------------------------
City | CORBIN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40701-8070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-595-3218
-----------------------------------------------------
Fax | 606-215-8372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DUSTIN B PHILLIPS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 606-595-3218
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------