MEDICARE: AUBRE PHILLIPS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1376900662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBRE PHILLIPS

Provider Business Mailing Address
First Line	:	3186 W HWY 412
Second Line	:
City	:	WEST SILOAM SPRINGS
State	:	OK
Zip	:	74338-1356
Country	:	US
Telephone Number	:	918-708-3006
Fax Number	:	919-205-2712

Provider Business Practice Location Address
First Line	:	3186 W HWY 412
Second Line	:
City	:	WEST SILOAM SPRINGS
State	:	OK
Zip	:	74338-1356
Country	:	US
Telephone Number	:	918-708-3006
Fax Number	:	919-205-2712

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

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	08/21/2020

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Directions to “ AUBRE PHILLIPS ” Practice Location

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