| Doctor Name: | JERRY FRANKLIN PHILLIPS |
| NPI Number: | 1114103751 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC |
| License Number: | M-4358 |
| Business Practice Address: | 3420 Hwy 27/441 Fruitland Park, FL - 347314474 |
| Business Phone Number: | 3524354631 |
| Business Fax Number: | 3524354632 |
| Mailing Address: | 3420 Hwy 27/441, FRUITLAND PARK |
| State: | FL |
| Postal Code: | 347314474 |
| Phone Number: | 3524354631 |
| Fax Number: | 3524354632 |
| NPI Enumeration Date: | 01/14/2008 |
| NPI Last Update Date: | 07/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | M-4358 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |