Provider Demographics
NPI:1639776941
Name:HOWELL, PHILLIP D (LPC-IT)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:D
Last Name:HOWELL
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 W BURLEIGH ST STE 11
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3102
Mailing Address - Country:US
Mailing Address - Phone:262-345-7421
Mailing Address - Fax:
Practice Address - Street 1:2222 N MAYFAIR RD STE 120
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2262
Practice Address - Country:US
Practice Address - Phone:414-939-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4234-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional