Provider Demographics
NPI:1811243926
Name:PHILLIPS, BRIANNE (LSCSW, LCSW, RPT-S)
Entity type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LSCSW, LCSW, RPT-S
Other - Prefix:
Other - First Name:BRIANNE
Other - Middle Name:
Other - Last Name:KNEESHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 N SUMAC ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-2211
Mailing Address - Country:US
Mailing Address - Phone:913-439-8176
Mailing Address - Fax:
Practice Address - Street 1:825 N SUMAC ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-2211
Practice Address - Country:US
Practice Address - Phone:913-439-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120245411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical