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NPI Code Detail

MEDICARE: MR. PHILLIP STEPHENS LMSW

MEDICARE: MR. PHILLIP STEPHENS LMSW
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
11041C0700XClinical Social Worker13040-MAR

General Provider Information

NPI Number : 1285415018
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILLIP STEPHENS LMSW
Provider Business Mailing Address
First Line : 620 S 21ST ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-3915
Country : US
Telephone Number : 479-785-4083
Fax Number : 479-434-6248
Provider Business Practice Location Address
First Line : 1055 SUNFLOWER DR STE 104
Second Line :
City : CONWAY
State : AR
Zip : 72034-3651
Country : US
Telephone Number : 501-697-6631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2023
Last Update Date : 10/09/2023

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