Provider Demographics
NPI:1952819716
Name:PHILLIPS, TENISHA (PHD, LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:TENISHA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 W CULLERTON ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3480
Mailing Address - Country:US
Mailing Address - Phone:312-624-8807
Mailing Address - Fax:
Practice Address - Street 1:960 W CULLERTON ST APT 2C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3480
Practice Address - Country:US
Practice Address - Phone:312-450-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2023-02-05
Deactivation Date:2022-12-17
Deactivation Code:
Reactivation Date:2023-01-09
Provider Licenses
StateLicense IDTaxonomies
IL180.014888101YM0800X
IL178.013273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health