Provider Demographics
NPI:1891181079
Name:WOOD, PHILLIP OWEN (LCPC, DMIN)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:OWEN
Last Name:WOOD
Suffix:
Gender:M
Credentials:LCPC, DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 AZTEC DR
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-1533
Mailing Address - Country:US
Mailing Address - Phone:630-668-1200
Mailing Address - Fax:
Practice Address - Street 1:130 SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-1961
Practice Address - Country:US
Practice Address - Phone:630-668-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health