Provider Demographics
NPI:1467913228
Name:PHILLIPS MENTAL HEALTH COUNSELING, P.C
Entity Type:Organization
Organization Name:PHILLIPS MENTAL HEALTH COUNSELING, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC, NCC
Authorized Official - Phone:631-470-2138
Mailing Address - Street 1:4 BROAD PATH
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-9763
Mailing Address - Country:US
Mailing Address - Phone:917-692-1459
Mailing Address - Fax:
Practice Address - Street 1:19402 NORTHERN BLVD STE 212
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3003
Practice Address - Country:US
Practice Address - Phone:631-692-1459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty