Provider Demographics
NPI:1376900662
Name:PHILLIPS, AUBRE
Entity Type:Individual
Prefix:
First Name:AUBRE
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 1:3186 W HWY 412
Mailing Address - Street 2:
Mailing Address - City:WEST SILOAM SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74338-1356
Mailing Address - Country:US
Mailing Address - Phone:918-708-3006
Mailing Address - Fax:919-205-2712
Practice Address - Street 1:3186 W HWY 412
Practice Address - Street 2:
Practice Address - City:WEST SILOAM SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74338-1356
Practice Address - Country:US
Practice Address - Phone:918-708-3006
Practice Address - Fax:919-205-2712
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health