Provider Demographics
NPI:1255496790
Name:PHILLIPS, MARY L (LIMHP, LMHP, CPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LIMHP, LMHP, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 ARBOR ST STE 110
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2975
Mailing Address - Country:US
Mailing Address - Phone:402-414-4746
Mailing Address - Fax:855-918-3603
Practice Address - Street 1:11711 ARBOR ST STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2975
Practice Address - Country:US
Practice Address - Phone:402-414-4746
Practice Address - Fax:855-918-3603
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2501101YM0800X
NE1362101YM0800X
NE570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE230777OtherMIDLANDS CHOICE
NE10025268300Medicaid
NE85313OtherBCBS
NE10025268300Medicaid