Provider Demographics
NPI:1619212016
Name:PHILLIPS, SARAH MICHELE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MICHELE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MICHELE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1414 E BOISE PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9237
Mailing Address - Country:US
Mailing Address - Phone:918-813-0736
Mailing Address - Fax:
Practice Address - Street 1:1414 E BOISE PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9237
Practice Address - Country:US
Practice Address - Phone:918-813-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OK1157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health