Provider Demographics
NPI:1972835478
Name:PHILLIPS, VANESSA ASHLEY (LMSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ASHLEY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MESQUITE CIR UNIT J134
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1957
Mailing Address - Country:US
Mailing Address - Phone:602-885-4700
Mailing Address - Fax:
Practice Address - Street 1:2400 N CENTRAL AVE STE 400
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1315
Practice Address - Country:US
Practice Address - Phone:602-264-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW 12594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health