Doctor Name: | MRS. JAMIE DAWN PHILLIPS |
NPI Number: | 1093854556 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | 2685 |
Business Practice Address: | 1300 Summers Pl Ponca City, OK - 746044443 |
Business Phone Number: | 5807624156 |
Business Fax Number: | 5807678754 |
Mailing Address: | 2108 Oriole St, PONCA CITY |
State: | OK |
Postal Code: | 746011134 |
Phone Number: | 5807671269 |
Fax Number: | 5807623299 |
NPI Enumeration Date: | 02/05/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2685 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |