Active NPI
Dennis R Phillips, SUDP
- Addiction (Substance Use Disorder) Counselor
- Everett, WA
National Provider Identifier
1356940480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CP61023845
- Practice address
- 811 Madison St
Everett, WA 98203-4543 - Phone
- (425) 212-4200
- Fax
- (425) 212-4201
- NPI assigned
- Oct 20, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CP61023845 | WA | Primary |
Addresses
Primary practice location
811 Madison St
Everett, WA 98203-4543
Mailing address
PO Box 2569
Everett, WA 98213-0569
Phone (425) 212-4200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CP61023845 | WA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1356940480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2569",
"city": "EVERETT",
"state": "WA",
"postal_code": "982130569",
"telephone_number": "425-212-4200",
"fax_number": "425-212-4201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 MADISON ST",
"city": "EVERETT",
"state": "WA",
"postal_code": "982034543",
"telephone_number": "425-212-4200",
"fax_number": "425-212-4201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "DENNIS",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "SUDP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-20",
"last_updated": "2020-10-28",
"certification_date": "2020-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WA",
"license": "CP61023845",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.