Provider Demographics
NPI:1346489895
Name:PHILLIPS, RONALD KENT (MA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:KENT
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 1:333 N. MICHIGAN AVENUE
Mailing Address - Street 2:SUITE # 602
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1033
Mailing Address - Country:US
Mailing Address - Phone:269-277-6657
Mailing Address - Fax:
Practice Address - Street 1:333 N. MICHIGAN AVENUE
Practice Address - Street 2:SUITE # 602
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-1033
Practice Address - Country:US
Practice Address - Phone:269-277-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010068101YM0800X
MI6301012652103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist