Provider Demographics
NPI:1720143886
Name:PHILLIPS, JOANN LYNN (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 GEORGIAN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-6236
Mailing Address - Country:US
Mailing Address - Phone:574-231-8847
Mailing Address - Fax:
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:SUITE #305, INTRIGUE COUNSELING
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1625
Practice Address - Country:US
Practice Address - Phone:574-234-3515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33004973A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker