Provider Demographics
NPI:1225048655
Name:PHILLIPS, BRETT A (LISW, LMHP)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LISW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534-0163
Mailing Address - Country:US
Mailing Address - Phone:712-527-3030
Mailing Address - Fax:
Practice Address - Street 1:501 TYSON ST
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1735
Practice Address - Country:US
Practice Address - Phone:712-527-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2674101YM0800X
IA064921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical