Provider Demographics
NPI:1407147085
Name:PHILLIPS, SIDNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
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 1:23410 BRAZOS ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:TX
Mailing Address - Zip Code:77445-4181
Mailing Address - Country:US
Mailing Address - Phone:281-734-7419
Mailing Address - Fax:832-201-0902
Practice Address - Street 1:23410 BRAZOS ESTATES RD
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-4181
Practice Address - Country:US
Practice Address - Phone:281-734-7419
Practice Address - Fax:832-201-0902
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10236101YA0400X
TX504231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)