Basic Information
| Provider Information | |||||||||
| NPI: | 1336412501 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHILLIPS COUNSELING SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1606 | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836531606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084674889 | ||||||||
| FaxNumber: | 2084674499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1224 1ST ST S | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836513900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084674889 | ||||||||
| FaxNumber: | 2084674499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2012 | ||||||||
| LastUpdateDate: | 02/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | ELLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2084674889 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | LCSW-28818 | ID | N | Agencies | Case Management | 261QR0400X | LCSW-28818 | ID | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | 261Q00000X | LCSW-28818 | ID | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.