Provider Demographics
NPI:1821337833
Name:PHILLIPS, CYNTHIA CONSUELA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CONSUELA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-3907
Mailing Address - Country:US
Mailing Address - Phone:773-238-1100
Mailing Address - Fax:773-238-4905
Practice Address - Street 1:11111 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-3907
Practice Address - Country:US
Practice Address - Phone:773-238-1100
Practice Address - Fax:773-238-4905
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health