Provider Demographics
NPI:1508183591
Name:PHILLIPS, RACHAEL RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:RENEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5547 LEDGESONE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2025
Mailing Address - Country:US
Mailing Address - Phone:214-820-2669
Mailing Address - Fax:214-820-9606
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-2669
Practice Address - Fax:214-820-9606
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical