Provider Demographics
NPI:1912073123
Name:COOLING, PHYLLIS J (CSW)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:J
Last Name:COOLING
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1227
Mailing Address - Country:US
Mailing Address - Phone:812-426-9779
Mailing Address - Fax:812-463-7874
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9779
Practice Address - Fax:812-463-7874
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000114A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000220131OtherANTHEM
IN839900CMedicare PIN
IN000000220131OtherANTHEM
IN257900EEEEMedicare PIN