Provider Demographics
NPI:1134342926
Name:HESS, PHYLLIS ELIZABETH (MASTER OF SCIENCE)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ELIZABETH
Last Name:HESS
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4800
Mailing Address - Country:US
Mailing Address - Phone:918-341-1955
Mailing Address - Fax:
Practice Address - Street 1:408 E WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-7455
Practice Address - Country:US
Practice Address - Phone:918-283-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)