Faith L. Phillips, PH.D., PLLC
Organization Active NPI Clinical Child & Adolescent Psychologist · Broken Bow, OK
NPI 1104079474 · NPPES record last updated Jun 1, 2012
Key facts
- NPI
- 1104079474
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Child & Adolescent Psychologist 103TC2200X
- License
- 513 (OK)
- Legal business name
- FAITH L. PHILLIPS, PH.D., PLLC
- Practice address
- 411 S. Park Drive
Broken Bow, OK 74728-3331 - Phone
- (580) 584-5550
- Fax
- (866) 584-1223
- NPI assigned
- Oct 29, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Faith L Phillips, PH.D.
- Title
- Psychologist
- Phone
- (580) 584-5550
National Provider Directory
Locations
411 S Park Dr
Broken Bow, OK 74728
Phone (580) 584-5550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist |
103TC2200X | 513 | OK | Yes |
Addresses
Primary practice location
411 S. Park Drive
Broken Bow, OK 74728-3331
Mailing address
411 S. Park Drive
Broken Bow, OK 74728-3331
Phone (580) 584-5550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200216630A | Medicaid | OK |
Other providers in Broken Bow, OK
- Complete Care Medical, Inc.
- Steven M Deaton
- Rhonda Jo Deramus
- E D Allens Pharmacy of Broken Bow Inc
- Kenneth G Ericksen
- Family Medical Clinic
- Tabitha Nicole Ferguson
- Alora S Fulgium
- Full Life Family Resource Center LLC
- Glover Elementary School
All providers in Broken Bow, OK · Clinical Child & Adolescent Psychologist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.