Provider Demographics
NPI:1629158001
Name:PHILLIPS, STEPHANIE JOY (MED, PCC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JOY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MED, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E HOLLISTER ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1704
Mailing Address - Country:US
Mailing Address - Phone:513-621-5001
Mailing Address - Fax:513-621-5008
Practice Address - Street 1:26 E HOLLISTER ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1704
Practice Address - Country:US
Practice Address - Phone:513-621-5001
Practice Address - Fax:513-621-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0007885101YP2500X
KYKY-0104101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional