MEDICARE: DR. YVETTE MICHELLE PHILLIPS PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	002675	MO
2	101YP2500X	Professional Counselor	63253	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	258635-000	OTHER	TX	MEGELLAN
3	7160205	OTHER	MO	AETNA
4	63253	OTHER	TX	CHAMPUS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	188424	OTHER	MO	BLUE CROSS BLUE SHIELD
7	33327021	OTHER	MO	BLUE CROSS BLUE SHIELD PP
8	34873012	OTHER	TX	FREEDOM NETWORK SELECT

General Provider Information

NPI Number	:	1265479562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVETTE MICHELLE PHILLIPS PSY.D.

Provider Business Mailing Address
First Line	:	6612 N RIVERSIDE DR UNIT 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6664
Country	:	US
Telephone Number	:	817-306-9770
Fax Number	:	817-306-9770

Provider Business Practice Location Address
First Line	:	6612 N RIVERSIDE DR UNIT 140
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-6664
Country	:	US
Telephone Number	:	817-306-9770
Fax Number	:	817-306-9770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	05/20/2009

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