Provider Demographics
NPI:1700290772
Name:PHILLIPS, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-7708
Mailing Address - Country:US
Mailing Address - Phone:484-294-3833
Mailing Address - Fax:484-294-3833
Practice Address - Street 1:349 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:ALBRIGHTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18210-7708
Practice Address - Country:US
Practice Address - Phone:484-294-3833
Practice Address - Fax:484-294-3833
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000870103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst