Provider Demographics
NPI:1932667458
Name:TKPHILLIPS COUNSELING, LLC
Entity Type:Organization
Organization Name:TKPHILLIPS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-INTERN
Authorized Official - Phone:971-727-5374
Mailing Address - Street 1:7420 SW HART PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6231
Mailing Address - Country:US
Mailing Address - Phone:971-727-5374
Mailing Address - Fax:
Practice Address - Street 1:11825 SW GREENBURG RD STE 208
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6466
Practice Address - Country:US
Practice Address - Phone:503-912-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty