Provider Demographics
NPI:1083744676
Name:PHILLIPS, SCOTT E (LMFT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 BURNET RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3319
Mailing Address - Country:US
Mailing Address - Phone:512-850-5208
Mailing Address - Fax:
Practice Address - Street 1:4412 BURNET RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3319
Practice Address - Country:US
Practice Address - Phone:512-850-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45831106H00000X
TX201683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist