Provider Demographics
NPI:1336412501
Name:PHILLIPS COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:PHILLIPS COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-467-4889
Mailing Address - Street 1:PO BOX 1606
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83653-1606
Mailing Address - Country:US
Mailing Address - Phone:208-467-4889
Mailing Address - Fax:208-467-4499
Practice Address - Street 1:1224 1ST ST S
Practice Address - Street 2:SUITE 307
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3900
Practice Address - Country:US
Practice Address - Phone:208-467-4889
Practice Address - Fax:208-467-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-28818251B00000X, 261Q00000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251B00000XAgenciesCase Management
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation