MEDICARE: MR. JONATHAN H. PHILLIPS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	245	CO

General Provider Information

NPI Number	:	1225070642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN H. PHILLIPS LCSW

Provider Business Mailing Address
First Line	:	1553 S BEECH ST
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-3732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 BROADWAY
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2526
Country	:	US
Telephone Number	:	303-813-4308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/08/2007

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