Provider Demographics
NPI:1972290435
Name:PHILLIPS, ROBIN RENEE (LPCA)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MUNFORDVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42765-9023
Mailing Address - Country:US
Mailing Address - Phone:606-875-9733
Mailing Address - Fax:
Practice Address - Street 1:1411 NORTH RACE STR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3474
Practice Address - Country:US
Practice Address - Phone:270-380-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263916101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health