Provider Demographics
NPI:1396158952
Name:PHILLIPS, MATTHEW CRAIG
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CRAIG
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 ADAMS ST NE
Mailing Address - Street 2:D40
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-8052
Mailing Address - Country:US
Mailing Address - Phone:505-977-1464
Mailing Address - Fax:
Practice Address - Street 1:3299 ADAMS ST NE
Practice Address - Street 2:D40
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-8052
Practice Address - Country:US
Practice Address - Phone:505-977-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor