Provider Demographics
NPI:1932279890
Name:PROTHERO, PHIL (MA, MDIV, LCMHC)
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:
Last Name:PROTHERO
Suffix:
Gender:M
Credentials:MA, MDIV, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-1132
Mailing Address - Country:US
Mailing Address - Phone:802-356-1731
Mailing Address - Fax:
Practice Address - Street 1:205 BILLINGS FARM RD STE 2D
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001
Practice Address - Country:US
Practice Address - Phone:802-356-1731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00047624101YM0800X
WALH00011059101YM0800X
VT068.0076445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health