Provider Demographics
NPI:1245331073
Name:ULM, PHILIP H (PSY D)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:H
Last Name:ULM
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 N SEMINARY ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-1251
Mailing Address - Country:US
Mailing Address - Phone:309-344-1000
Mailing Address - Fax:309-344-1054
Practice Address - Street 1:834 NORTH SEMINARY STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-344-9444
Practice Address - Fax:309-717-0124
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1800010302084P0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5092671OtherAETNA
10741209OtherCAQH
4815127OtherBC/BS