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General NPI Number Information
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NPI Number | 1407517337
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Entity Type | Individual
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Provider Name | BENJAMIN PHILLIPS LPC
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Gender | Male
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Dates
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Enumeration Date | 01/03/2022
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 107 W 11TH ST
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City | DELTA
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State | CO
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Zip | 81416-1811
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Country | US
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Telephone | 970-252-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MERCURY VILLAGE DR
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City | DURANGO
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State | CO
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Zip | 81301-8955
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Country | US
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Telephone | 970-335-2422
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0021489
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License Number State | CO
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