Healthcare Provider Details

I. General information

NPI: 1013211234
Provider Name (Legal Business Name): MR. ANTHONY PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. ANTHONY PHILLIPS

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 1ST ST SUITE#200
ALBUQUERQUE NM
87102
US

IV. Provider business mailing address

5800 HARPER DR NE APT#203
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-2203
  • Fax:
Mailing address:
  • Phone: 505-804-2203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: