Provider Demographics
NPI:1497804850
Name:PHILLIPPI, STEPHEN WHEAT JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WHEAT
Last Name:PHILLIPPI
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-1443
Mailing Address - Country:US
Mailing Address - Phone:985-867-8135
Mailing Address - Fax:
Practice Address - Street 1:725 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1443
Practice Address - Country:US
Practice Address - Phone:985-867-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical