Provider Demographics
NPI:1982956298
Name:PHILLIPS, JEREMY (MS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NATRONA HTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2426
Mailing Address - Country:US
Mailing Address - Phone:724-757-4454
Mailing Address - Fax:
Practice Address - Street 1:2318 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1651
Practice Address - Country:US
Practice Address - Phone:724-757-6119
Practice Address - Fax:724-409-6060
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YS0200X
PAPC006789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool