Provider Demographics
NPI:1609867860
Name:PHILLIPS, DAVID LEE (MS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-8300
Mailing Address - Country:US
Mailing Address - Phone:425-953-4361
Mailing Address - Fax:425-953-4361
Practice Address - Street 1:1002 10TH ST
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2024
Practice Address - Country:US
Practice Address - Phone:425-953-4361
Practice Address - Fax:425-953-4361
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7444PHOtherREGENCE BLUE SHIELD
WA056368OtherHORIZON BEHAV. SERV. ID #
WA2030370OtherCIGNA BEHAV. HEALTH ID #
WA8927542OtherCRIME VICTIMS COMP
WA555451001OtherGROUP HEALTH ID #
WA205394OtherMANGED HEALTH NETWORK ID
WA182368OtherCOMPSYCH
WA205394OtherMANGED HEALTH NETWORK ID