Provider Demographics
NPI:1558616821
Name:PREWITT, PHILIP THOMAS (LPC)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:THOMAS
Last Name:PREWITT
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 1:3536 LEYDEN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-1342
Mailing Address - Country:US
Mailing Address - Phone:720-937-9565
Mailing Address - Fax:
Practice Address - Street 1:3536 LEYDEN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1342
Practice Address - Country:US
Practice Address - Phone:720-722-3516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional