Provider Demographics
NPI:1396901146
Name:PHILLIPS, HENRY DANIEL (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:DANIEL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MANCHESTER RD
Mailing Address - Street 2:SUITE 1510
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4561
Mailing Address - Country:US
Mailing Address - Phone:630-653-1717
Mailing Address - Fax:
Practice Address - Street 1:2100 MANCHESTER RD
Practice Address - Street 2:SUITE 1510
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4561
Practice Address - Country:US
Practice Address - Phone:630-653-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007396101YP2500X
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)