Provider Demographics
NPI:1154660504
Name:PHILLIPS, OLIVIA DELACEY (MSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DELACEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4083
Mailing Address - Country:US
Mailing Address - Phone:970-443-1061
Mailing Address - Fax:
Practice Address - Street 1:1 OLD TOWN SQ
Practice Address - Street 2:SUITE 200B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2464
Practice Address - Country:US
Practice Address - Phone:970-443-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13040101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health