Provider Demographics
NPI:1265479562
Name:PHILLIPS, YVETTE MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:MICHELLE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 N RIVERSIDE DR UNIT 140
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6664
Mailing Address - Country:US
Mailing Address - Phone:817-306-9770
Mailing Address - Fax:817-306-9770
Practice Address - Street 1:6612 N RIVERSIDE DR UNIT 140
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-6664
Practice Address - Country:US
Practice Address - Phone:817-306-9770
Practice Address - Fax:817-306-9770
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002675103TC0700X
TX63253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493990618Medicaid
TX258635-000OtherMEGELLAN
MO7160205OtherAETNA
TX63253OtherCHAMPUS
TX188361301Medicaid
MO188424OtherBLUE CROSS BLUE SHIELD
MO33327021OtherBLUE CROSS BLUE SHIELD PP
TX34873012OtherFREEDOM NETWORK SELECT