Healthcare Provider Details

I. General information

NPI: 1992114276
Provider Name (Legal Business Name): DR. SUSAN P. PHILLIPS, PH.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 WINDGUARD CIR SUITE 102
WESLEY CHAPEL FL
33544-7369
US

IV. Provider business mailing address

2824 WINDGUARD CIR SUITE 102
WESLEY CHAPEL FL
33544-7369
US

V. Phone/Fax

Practice location:
  • Phone: 813-997-4538
  • Fax: 813-991-7584
Mailing address:
  • Phone: 813-997-4538
  • Fax: 813-991-7584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY7291
License Number StateFL

VIII. Authorized Official

Name: DR. SUSAN P PHILLIPS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 813-997-4538