Provider Demographics
NPI:1265817043
Name:JANE PHILLIPS, PHD, LCSW & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:JANE PHILLIPS, PHD, LCSW & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:682-225-6990
Mailing Address - Street 1:3909 PALUXY HWY
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-5538
Mailing Address - Country:US
Mailing Address - Phone:682-225-6990
Mailing Address - Fax:817-732-3000
Practice Address - Street 1:4200 S HULEN ST
Practice Address - Street 2:SUITE 676
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4914
Practice Address - Country:US
Practice Address - Phone:682-225-6990
Practice Address - Fax:817-732-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ43855Medicare UPIN