Provider Demographics
NPI:1295019289
Name:PHILLIPS, EVA L
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 NE H ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-1956
Mailing Address - Country:US
Mailing Address - Phone:918-967-2476
Mailing Address - Fax:
Practice Address - Street 1:409 NE H ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1956
Practice Address - Country:US
Practice Address - Phone:918-967-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker