Provider Demographics
NPI:1235479171
Name:PHILLIPS, DELTA LYNN (MA, TRAINING SPECIAL)
Entity Type:Individual
Prefix:MS
First Name:DELTA
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, TRAINING SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 SWEET PINE ST.
Mailing Address - Street 2:UNIT 102
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3913 SWEET PINE ST.
Practice Address - Street 2:UNIT 102
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108
Practice Address - Country:US
Practice Address - Phone:702-636-0841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care