Provider Demographics
NPI:1720439367
Name:TAFS, PHILLIP (MSW, BCBA)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:TAFS
Suffix:
Gender:M
Credentials:MSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 MCCOLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1271
Mailing Address - Country:US
Mailing Address - Phone:907-268-1242
Mailing Address - Fax:
Practice Address - Street 1:2728 MCCOLLIE AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-1271
Practice Address - Country:US
Practice Address - Phone:907-268-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKBEVB14103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst