Provider Demographics
NPI:1831363969
Name:PHILLIPS, MARINDA DAWN (BCBA)
Entity type:Individual
Prefix:MS
First Name:MARINDA
Middle Name:DAWN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 PARK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7139
Mailing Address - Country:US
Mailing Address - Phone:731-695-4070
Mailing Address - Fax:
Practice Address - Street 1:2916 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7139
Practice Address - Country:US
Practice Address - Phone:731-695-4070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor