Craig Robert Phillips

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

5936-125 Issued in WI

Practice address

Physis Counseling LLC
770 South Main St Suite 24
Fond Du Lac, WI 54935-3556

Phone

(920) 960-8051

NPI assigned

Feb 19, 2014

Last updated

Nov 14, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1861817421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PHYSIS COUNSELING LLC",
            "address_2": "770 SOUTH MAIN ST SUITE 24",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "54935",
            "telephone_number": "920-960-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PHYSIS COUNSELING LLC",
            "address_2": "770 SOUTH MAIN ST SUITE 24",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353556",
            "telephone_number": "920-960-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "CRAIG",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-19",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "5936-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861817421",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100036100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen M Peterson
• Stacie Peterson
• Stefanie Mae Petrie, APNP
• Galina S Petrinska, M.D.
• Cathy Philipsky
• John S Phillips, D.D.S.
• Phoenix Rising LLC
• Shelley D Piasecki, M.D.
• Pickart Hearing Service, LLC
• Pickart Hearing Service, LLC

• Professional Counselor in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.