Provider Demographics
NPI:1568914216
Name:PHILLIPS, EMILY ANN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RICHMOND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3942
Mailing Address - Country:US
Mailing Address - Phone:985-732-2089
Mailing Address - Fax:985-732-2078
Practice Address - Street 1:302 RICHMOND ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3942
Practice Address - Country:US
Practice Address - Phone:985-732-2089
Practice Address - Fax:985-732-2078
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health