Provider Demographics
NPI:1285296681
Name:PHILIE, JUSTIN (MA, LCMHC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:PHILIE
Suffix:
Gender:M
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 BEN OBER HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-9270
Mailing Address - Country:US
Mailing Address - Phone:802-635-8971
Mailing Address - Fax:
Practice Address - Street 1:GREEN RIVER GUILD
Practice Address - Street 2:111 MAIN ST.
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655
Practice Address - Country:US
Practice Address - Phone:802-888-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134155101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health