Individual
MR. PHILLIP A. WILBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5241 FOUNTAIN DR, SUITE G, CROWN POINT, IN 46307-5323
(219) 381-5648
(219) 736-2998
Mailing address
3938 W 78TH CT, # 31, MERRILLVILLE, IN 46410-8705
(219) 381-5648
(219) 736-2998
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
149-001105
IL
1041C0700X
Clinical Social Worker
Primary
34001917A
IN
Other
Enumeration date
07/17/2006
Last updated
12/10/2011
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