Provider Demographics
NPI:1356087092
Name:PHILLIPS, JULIE (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:PHILLIPS
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 1:331 WASHAKIE ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2855
Mailing Address - Country:US
Mailing Address - Phone:423-509-5167
Mailing Address - Fax:
Practice Address - Street 1:555 MARRIOTT DR STE 315
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-5088
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSWB-2024-11271041C0700X
TN93861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical