Provider Demographics
NPI:1417172362
Name:PHILLIPS, LISA KAY (LMHC, LMSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:KAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMHC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 OSBURN AVE
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-9698
Mailing Address - Country:US
Mailing Address - Phone:641-673-6125
Mailing Address - Fax:
Practice Address - Street 1:120 N MARKET ST
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2827
Practice Address - Country:US
Practice Address - Phone:641-673-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01961104100000X
IA001101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker