Provider Demographics
NPI:1417533712
Name:IHEANACHO, PHYLLIS (LMSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:IHEANACHO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 MEREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2413
Mailing Address - Country:US
Mailing Address - Phone:713-517-2948
Mailing Address - Fax:
Practice Address - Street 1:1910 TEAKWOOD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-5413
Practice Address - Country:US
Practice Address - Phone:713-517-2948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker