Provider Demographics
NPI:1326187899
Name:PHILLIPS, LISA ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:REO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:421 ENQUIREE CT
Mailing Address - Street 2:APT. 304
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2223
Mailing Address - Country:US
Mailing Address - Phone:901-428-1974
Mailing Address - Fax:
Practice Address - Street 1:7410 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38135-1908
Practice Address - Country:US
Practice Address - Phone:901-252-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health