Provider Demographics
NPI:1053863530
Name:PHILLIPS, CYBELE WHITNEY (LAC)
Entity Type:Individual
Prefix:MS
First Name:CYBELE
Middle Name:WHITNEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7831 SE LAKE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2193
Mailing Address - Country:US
Mailing Address - Phone:206-683-7789
Mailing Address - Fax:
Practice Address - Street 1:7831 SE LAKE RD STE 102
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2193
Practice Address - Country:US
Practice Address - Phone:206-683-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC177817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist