Provider Demographics
NPI:1972801280
Name:GINSBURG, PHILLIP (LCDC, LPC INTERN)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:
Last Name:GINSBURG
Suffix:
Gender:M
Credentials:LCDC, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 JONES ROAD SUITE
Mailing Address - Street 2:287-9
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064
Mailing Address - Country:US
Mailing Address - Phone:832-375-1700
Mailing Address - Fax:832-375-1600
Practice Address - Street 1:12345 JONES ROAD SUITE
Practice Address - Street 2:287-9
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064
Practice Address - Country:US
Practice Address - Phone:832-375-1700
Practice Address - Fax:832-375-1600
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11176101YA0400X
TX66700101YP2500X
TX201583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist