Provider Demographics
NPI:1073401808
Name:PHILLIPS, ELLIOT (MA)
Entity type:Individual
Prefix:
First Name:ELLIOT
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 N WOLCOTT AVE APT 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2621
Mailing Address - Country:US
Mailing Address - Phone:917-459-3004
Mailing Address - Fax:
Practice Address - Street 1:500 DAVIS ST STE 815
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4655
Practice Address - Country:US
Practice Address - Phone:312-640-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health