Provider Demographics
NPI:1346839271
Name:PHILLIPS, MAX J (LCSW)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:U
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0924
Mailing Address - Country:US
Mailing Address - Phone:417-689-2565
Mailing Address - Fax:660-280-2965
Practice Address - Street 1:705 E LAHARPE ST
Practice Address - Street 2:SUITE C
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4556
Practice Address - Country:US
Practice Address - Phone:660-988-9669
Practice Address - Fax:660-280-2965
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200387721041C0700X
MO20230010491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical