Provider Demographics
NPI:1811294416
Name:ARISS, PHYLLIS JEAN (LMHC)
Entity type:Individual
Prefix:MISS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:ARISS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 S CAMINO DEL PUEBLO
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5927
Mailing Address - Country:US
Mailing Address - Phone:505-404-2073
Mailing Address - Fax:505-404-2083
Practice Address - Street 1:848 S CAMINO DEL PUEBLO
Practice Address - Street 2:SUITE 5
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5927
Practice Address - Country:US
Practice Address - Phone:505-404-2073
Practice Address - Fax:505-404-2083
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0136681101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor