Provider Demographics
NPI:1508624941
Name:EBERLY-PHILLIPS, MALINDA (LISW)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:EBERLY-PHILLIPS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:MOUNT EATON
Mailing Address - State:OH
Mailing Address - Zip Code:44659-0265
Mailing Address - Country:US
Mailing Address - Phone:330-359-6100
Mailing Address - Fax:330-597-9010
Practice Address - Street 1:4739 POWELL RD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8757
Practice Address - Country:US
Practice Address - Phone:330-359-6100
Practice Address - Fax:330-597-9010
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.24052461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical