Provider Demographics
NPI:1114669033
Name:KRISTIN M. PHILLIPS, PH.D., PLLC
Entity Type:Organization
Organization Name:KRISTIN M. PHILLIPS, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-701-2471
Mailing Address - Street 1:14448 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2612
Mailing Address - Country:US
Mailing Address - Phone:813-701-2471
Mailing Address - Fax:813-701-2471
Practice Address - Street 1:14448 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2612
Practice Address - Country:US
Practice Address - Phone:813-701-2471
Practice Address - Fax:813-701-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)