Provider Demographics
NPI:1558139469
Name:PHILLIPS, JAMA (LPCC)
Entity Type:Individual
Prefix:
First Name:JAMA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 2ND ST STE 406
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3174
Mailing Address - Country:US
Mailing Address - Phone:270-854-3132
Mailing Address - Fax:
Practice Address - Street 1:230 2ND ST STE 406
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3174
Practice Address - Country:US
Practice Address - Phone:270-854-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health