Provider Demographics
NPI:1518279421
Name:PHILLIPS, LUZETA (LADC CADIDATE)
Entity Type:Individual
Prefix:
First Name:LUZETA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LADC CADIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SE GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-4948
Mailing Address - Country:US
Mailing Address - Phone:405-605-8232
Mailing Address - Fax:
Practice Address - Street 1:500 SE GRAND BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-4948
Practice Address - Country:US
Practice Address - Phone:405-605-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst