Provider Demographics
NPI:1336689215
Name:PHILLIPS, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
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 1:1112 N BELL AVE
Mailing Address - Street 2:#2
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-3245
Mailing Address - Country:US
Mailing Address - Phone:806-388-7461
Mailing Address - Fax:
Practice Address - Street 1:1112 N BELL AVE
Practice Address - Street 2:#2
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76209-3245
Practice Address - Country:US
Practice Address - Phone:806-388-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor