Provider Demographics
NPI:1689278715
Name:PHILLIPS, MAYA TYLOR ELLA
Entity Type:Individual
Prefix:MISS
First Name:MAYA
Middle Name:TYLOR ELLA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 CHEW ST STE 105
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3412
Mailing Address - Country:US
Mailing Address - Phone:484-951-0690
Mailing Address - Fax:
Practice Address - Street 1:451 CHEW ST STE 105
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3412
Practice Address - Country:US
Practice Address - Phone:484-951-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health