Provider Demographics
NPI:1760587802
Name:PHILLIPS, MARCY P (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARCY
Middle Name:P
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 MARINE DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-4059
Mailing Address - Country:US
Mailing Address - Phone:503-338-6304
Mailing Address - Fax:503-338-6717
Practice Address - Street 1:1230 MARINE DR
Practice Address - Street 2:SUITE 305
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4059
Practice Address - Country:US
Practice Address - Phone:503-338-6304
Practice Address - Fax:503-338-6717
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC0797101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health