Provider Demographics
NPI:1376230276
Name:PHILLIPS, LISA M (NA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 WIPPRECHT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-3950
Mailing Address - Country:US
Mailing Address - Phone:832-339-6681
Mailing Address - Fax:
Practice Address - Street 1:12337 JONES RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4800
Practice Address - Country:US
Practice Address - Phone:209-591-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator