Provider Demographics
NPI:1114613247
Name:PHILLIPS, ANGELA R (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 S CARROLL BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-7423
Mailing Address - Country:US
Mailing Address - Phone:469-626-7511
Mailing Address - Fax:469-613-0883
Practice Address - Street 1:900 E PARK BLVD STE 280
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8862
Practice Address - Country:US
Practice Address - Phone:469-626-7511
Practice Address - Fax:469-613-0883
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109999104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker