Provider Demographics
NPI:1306724117
Name:PHILLIPS, MAURICE JR
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:PHILLIPS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18435 NE GLISAN ST APT 12
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-7276
Mailing Address - Country:US
Mailing Address - Phone:503-516-4470
Mailing Address - Fax:
Practice Address - Street 1:18435 NE GLISAN ST APT 12
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-7276
Practice Address - Country:US
Practice Address - Phone:503-516-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR518465101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool