Provider Demographics
NPI:1396847745
Name:PHILLIPS, DOROTHY JENNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JENNIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18484 PRESTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5474
Mailing Address - Country:US
Mailing Address - Phone:214-642-3618
Mailing Address - Fax:972-931-2317
Practice Address - Street 1:3500 OAK LAWN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4349
Practice Address - Country:US
Practice Address - Phone:214-642-3618
Practice Address - Fax:972-931-2317
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0638827-01Medicaid
TX00393EMedicare ID - Type Unspecified
TX00393EMedicare UPIN