Provider Demographics
NPI:1356832224
Name:PHILLIPS, KENT (THERAPIST)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4862 E BASELINE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4668
Mailing Address - Country:US
Mailing Address - Phone:480-981-2405
Mailing Address - Fax:480-306-6236
Practice Address - Street 1:4862 E BASELINE RD STE 108
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4668
Practice Address - Country:US
Practice Address - Phone:480-981-2405
Practice Address - Fax:480-306-6236
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)