Provider Demographics
NPI:1518992205
Name:PHILLIPS, ROBERT L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18575 SW CENTURY DR
Mailing Address - Street 2:#2033
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1950
Mailing Address - Country:US
Mailing Address - Phone:503-238-9755
Mailing Address - Fax:
Practice Address - Street 1:18575 SW CENTURY DR # 2033
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1950
Practice Address - Country:US
Practice Address - Phone:503-238-9755
Practice Address - Fax:458-256-3185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C6738101YM0800X
ORC6738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health