Provider Demographics
NPI:1710259544
Name:PHILLIPS, CRUGER JOHNSON (LPC)
Entity Type:Individual
Prefix:MS
First Name:CRUGER
Middle Name:JOHNSON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1924
Mailing Address - Country:US
Mailing Address - Phone:860-561-1175
Mailing Address - Fax:860-561-3382
Practice Address - Street 1:90 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1924
Practice Address - Country:US
Practice Address - Phone:860-561-1175
Practice Address - Fax:860-561-3382
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional