Provider Demographics
NPI:1770889693
Name:PHILLIPS, YVETTE (MSW)
Entity type:Individual
Prefix:MS
First Name:YVETTE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 W. FREEPORT ST.
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-851-1982
Mailing Address - Fax:
Practice Address - Street 1:5553 S PEORIA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-6800
Practice Address - Country:US
Practice Address - Phone:918-852-4695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health