Provider Demographics
NPI:1184816951
Name:PHILLIPS, EVAN DUANE
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:DUANE
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
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 179
Mailing Address - Street 2:
Mailing Address - City:SEAVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98644-0179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 PIER 1
Practice Address - Street 2:STE. 308
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6300
Practice Address - Country:US
Practice Address - Phone:503-325-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)