Organization Name: | FAITH L. PHILLIPS, PH.D., PLLC |
NPI Number: | 1104079474 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FAITH L PHILLIPS (PSYCHOLOGIST) |
Mailing Address: | 411 S. Park Drive Broken Bow |
State: | OK US |
Postal Code: | 747283331 |
Phone Number: | 5805845550 |
Fax Number: | 8665841223 |
NPI Enumeration Date: | 10/29/2008 |
NPI Last Update Date: | 06/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC2200X |
License Number: | 513 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical Child & Adolescent |
Taxonomy Definition: |