MEDICARE: MS. JEANA L. PHILLIPS LPC

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	101YM0800X	Mental Health Counselor	C3243	OR

General Provider Information

NPI Number	:	1245507771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEANA L. PHILLIPS LPC

Provider Business Mailing Address
First Line	:	PO BOX 251
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-0251
Country	:	US
Telephone Number	:	541-403-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1937 WASHINGTON AVE
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-3353
Country	:	US
Telephone Number	:	541-403-4322
Fax Number	:

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	03/04/2016

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