Provider Demographics
NPI:1629346952
Name:PHILLIPS, TAMARA FAYE (MA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:FAYE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 HWY 55 STE 402
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3868
Mailing Address - Country:US
Mailing Address - Phone:612-326-3157
Mailing Address - Fax:612-564-7195
Practice Address - Street 1:12805 HWY 55 STE 402
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3868
Practice Address - Country:US
Practice Address - Phone:612-326-3157
Practice Address - Fax:612-564-7195
Is Sole Proprietor?:No
Enumeration Date:2011-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist