Provider Demographics
NPI:1992179378
Name:PHILIPS, KARLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 COLONIAL BLVD STE C21
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1004
Mailing Address - Country:US
Mailing Address - Phone:561-300-4854
Mailing Address - Fax:
Practice Address - Street 1:1342 COLONIAL BLVD STE C21
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1004
Practice Address - Country:US
Practice Address - Phone:561-300-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-22
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW165931041C0700X
MI68011006261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical