Provider Demographics
NPI:1629154588
Name:PHILLIPS, ROSE STEEG (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:STEEG
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 SANDIA DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5308
Mailing Address - Country:US
Mailing Address - Phone:928-717-2505
Mailing Address - Fax:928-717-2504
Practice Address - Street 1:3101 CLEARWATER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305
Practice Address - Country:US
Practice Address - Phone:928-717-2505
Practice Address - Fax:928-717-2504
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT 10202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ960973Medicaid