Provider Demographics
NPI:1275277154
Name:PHIPPS, HAILEY M (LAC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:M
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 E GUADALUPE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3971
Mailing Address - Country:US
Mailing Address - Phone:480-921-3314
Mailing Address - Fax:
Practice Address - Street 1:1405 E GUADALUPE RD STE 3
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3971
Practice Address - Country:US
Practice Address - Phone:480-921-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-20769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health