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NPI Code Detail

MEDICARE: MS. PATRICIA KISTE PHILLIPS LCSW

MEDICARE: MS. PATRICIA KISTE PHILLIPS LCSW
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 WorkerC8535MS
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M8535OTHERMSLMSW

General Provider Information

NPI Number : 1851482178
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PATRICIA KISTE PHILLIPS LCSW
Provider Business Mailing Address
First Line : PO BOX 53
Second Line :
City : THAXTON
State : MS
Zip : 38871-0053
Country : US
Telephone Number : 662-231-4509
Fax Number :
Provider Business Practice Location Address
First Line : 152 HIGHWAY 7 S
Second Line :
City : OXFORD
State : MS
Zip : 38655-5392
Country : US
Telephone Number : 662-234-7521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 03/26/2019

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