Provider Demographics
NPI:1346839271
Name:PHILLIPS, MADISON JANE (LMSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:JANE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 TIGER LN APT 219
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-8112
Mailing Address - Country:US
Mailing Address - Phone:417-689-2565
Mailing Address - Fax:
Practice Address - Street 1:302 CAMPUSVIEW DR STE 202
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7506
Practice Address - Country:US
Practice Address - Phone:573-328-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200387721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical