MEDICARE: EDWARD DUSTIN PHILLIPS

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	103K00000X	Behavior Analyst	BACB1549115	CO

General Provider Information

NPI Number	:	1780511014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD DUSTIN PHILLIPS

Provider Business Mailing Address
First Line	:	1322 NUTWOOD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7759
Country	:	US
Telephone Number	:	970-531-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 NUTWOOD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7759
Country	:	US
Telephone Number	:	970-531-6357
Fax Number	:

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

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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Directions to “ EDWARD DUSTIN PHILLIPS ” Practice Location

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