Provider Demographics
NPI:1942774286
Name:PHILLIPS, MARGARET KATHLEEN (ED S, T-LMLP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:KATHLEEN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:ED S, T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 N CULEN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1154
Mailing Address - Country:US
Mailing Address - Phone:316-393-7002
Mailing Address - Fax:
Practice Address - Street 1:1855 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3413
Practice Address - Country:US
Practice Address - Phone:316-636-2888
Practice Address - Fax:316-636-2366
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2896103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral