Provider Demographics
NPI:1710168828
Name:PHILLIPS, PAULINE ELIZABETH (CSW, LMFT)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:ELIZABETH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CSW, LMFT
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:ELIZABETH
Other - Last Name:PRITCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW, LMFT
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-944-2532
Mailing Address - Fax:812-944-2549
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 18
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-944-2532
Practice Address - Fax:812-944-2549
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5295104100000X
KY0784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30605018Medicaid
KY000000543837OtherANTHEM