Provider Demographics
NPI:1497335160
Name:PHILLIPS, THORN T (LPC)
Entity Type:Individual
Prefix:MR
First Name:THORN
Middle Name:T
Last Name:PHILLIPS
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 1:23363 S ROBIN RD # QUADB
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-7381
Mailing Address - Country:US
Mailing Address - Phone:985-624-4118
Mailing Address - Fax:985-624-4123
Practice Address - Street 1:23363 S ROBIN RD # QUADB
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7381
Practice Address - Country:US
Practice Address - Phone:985-624-4118
Practice Address - Fax:985-690-6662
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC7769101YP2500X, 171M00000X, 101YA0400X
LAPLC7769101YP2500X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator