Provider Demographics
NPI:1326491630
Name:ELIZABETH ELLEN TERRELL PHILLIPS
Entity Type:Organization
Organization Name:ELIZABETH ELLEN TERRELL PHILLIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:TERRELL PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-282-0646
Mailing Address - Street 1:2300 ANTELOPE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3550
Mailing Address - Country:US
Mailing Address - Phone:970-282-0230
Mailing Address - Fax:
Practice Address - Street 1:3307 S COLLEGE AVE UNIT 200-13
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4196
Practice Address - Country:US
Practice Address - Phone:970-282-0646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty