Provider Demographics
NPI:1710622246
Name:PHILLIPS, ELAINE M (LPC-A)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16911 COUNTY ROAD 122
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-8026
Mailing Address - Country:US
Mailing Address - Phone:903-871-3450
Mailing Address - Fax:
Practice Address - Street 1:16911 COUNTY ROAD 122
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-8026
Practice Address - Country:US
Practice Address - Phone:903-871-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional