Provider Demographics
NPI:1215726278
Name:PHILLIPPI, JUSTIN CASEY
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CASEY
Last Name:PHILLIPPI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 11TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-3616
Mailing Address - Country:US
Mailing Address - Phone:701-388-9346
Mailing Address - Fax:
Practice Address - Street 1:1017 11TH ST S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-3616
Practice Address - Country:US
Practice Address - Phone:701-388-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling