Healthcare Provider Details

I. General information

NPI: 1912454752
Provider Name (Legal Business Name): JOSIE J PHILLIPS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOSIE GUTHRIE

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 COLLEGE AVE
ST. MARIES ID
83837-2073
US

IV. Provider business mailing address

PO BOX 1387
HAYDEN ID
83835-1387
US

V. Phone/Fax

Practice location:
  • Phone: 208-245-4363
  • Fax: 208-245-4349
Mailing address:
  • Phone: 208-415-0299
  • Fax: 208-625-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number40643
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: