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NPI Code Detail

MEDICARE: MRS. CYNTHIA CONSUELA PHILLIPS LCPC

MEDICARE: MRS. CYNTHIA CONSUELA PHILLIPS LCPC
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
1101YM0800XMental Health CounselorIL
2101YP2500XProfessional CounselorIL

General Provider Information

NPI Number : 1821337833
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CYNTHIA CONSUELA PHILLIPS LCPC
Provider Business Mailing Address
First Line : 11111 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3907
Country : US
Telephone Number : 773-238-1100
Fax Number : 773-238-4905
Provider Business Practice Location Address
First Line : 11111 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3907
Country : US
Telephone Number : 773-238-1100
Fax Number : 773-238-4905
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2013
Last Update Date : 02/11/2013

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