Provider Demographics
NPI:1083825350
Name:PHILLIP, TONY ANTHONY (PLMHP)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:ANTHONY
Last Name:PHILLIP
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16075 OAK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2046
Mailing Address - Country:US
Mailing Address - Phone:402-453-5388
Mailing Address - Fax:402-451-3893
Practice Address - Street 1:5620 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2754
Practice Address - Country:US
Practice Address - Phone:402-453-5388
Practice Address - Fax:402-451-3893
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health