Provider Demographics
NPI:1578109542
Name:CEPHAS, PHYLLIS RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:RENEE
Last Name:CEPHAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N. BELT LINE ROAD
Mailing Address - Street 2:#728
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:214-801-8942
Mailing Address - Fax:
Practice Address - Street 1:2200 N. BELT LINE ROAD
Practice Address - Street 2:#728
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:214-801-8942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional