Provider Demographics
NPI:1417413618
Name:CLARY, PHILIP (LPC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:
Last Name:CLARY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KATELYN CIR STE B
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6483
Mailing Address - Country:US
Mailing Address - Phone:478-953-2122
Mailing Address - Fax:478-953-2060
Practice Address - Street 1:100 KATELYN CIR STE B
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6483
Practice Address - Country:US
Practice Address - Phone:478-953-2122
Practice Address - Fax:478-953-2060
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional