Provider Demographics
NPI:1952686081
Name:PHILLIPS, TRISHA A (MS, CSADC, MISA I)
Entity Type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, CSADC, MISA I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 W LINCOLN BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4976
Mailing Address - Country:US
Mailing Address - Phone:815-232-1913
Mailing Address - Fax:815-235-8157
Practice Address - Street 1:773 W LINCOLN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4976
Practice Address - Country:US
Practice Address - Phone:815-232-1913
Practice Address - Fax:815-235-8157
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL22902101YA0400X, 101YM0800X
IL60432101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health