Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 16663 | PA |
NPI | 1295486009 |
---|---|
Provider Name | Dr. David Peeair Phillips |
First Address | Tobyhanna, PA 18466-8218 |
Second Address | Mount Pocono, PA 18344-1046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2022 |
Last Update Date | 13/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2972261 | (05) | PA |