Healthcare Provider Details

I. General information

NPI: 1851026967
Provider Name (Legal Business Name): ALISON RAE PHILLIPS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISON RAE PHILLIPS-COLEMAN LCSW

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 N DATE ST STE 138
TRUTH OR CONSEQUENCES NM
87901-3701
US

IV. Provider business mailing address

1902 N DATE ST STE 138
TRUTH OR CONSEQUENCES NM
87901-3701
US

V. Phone/Fax

Practice location:
  • Phone: 317-720-1021
  • Fax:
Mailing address:
  • Phone: 317-720-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006812A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-0099
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW00001350
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: