Healthcare Provider Details

I. General information

NPI: 1306759063
Provider Name (Legal Business Name): TIANA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5023 E 56TH ST STE 220
INDIANAPOLIS IN
46226-1471
US

IV. Provider business mailing address

8224 BELLA VISTA BLVD APT 4205
FISHERS IN
46038-3127
US

V. Phone/Fax

Practice location:
  • Phone: 317-563-1117
  • Fax:
Mailing address:
  • Phone: 317-563-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33014226A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: