Provider Demographics
NPI:1396774568
Name:PHILIPS, MARSHA LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:LYNN
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231142
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70183-1142
Mailing Address - Country:US
Mailing Address - Phone:504-734-8825
Mailing Address - Fax:504-734-8826
Practice Address - Street 1:1529 RIVER OAKS RD W
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2162
Practice Address - Country:US
Practice Address - Phone:504-734-8825
Practice Address - Fax:504-734-8826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA599103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA20765OtherBCBS
LA163405OtherVALUE OPTIONS
LA2099762OtherCIGNA
LA5S545Medicare ID - Type UnspecifiedMEDICARE NUMBER