Provider Demographics
NPI:1194396382
Name:YORK, PHYLLIS B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:B
Last Name:YORK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 CIRCLE WAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5239
Mailing Address - Country:US
Mailing Address - Phone:979-388-3678
Mailing Address - Fax:
Practice Address - Street 1:129 CIRCLE WAY ST STE B
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5239
Practice Address - Country:US
Practice Address - Phone:979-388-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health