Healthcare Provider Details

I. General information

NPI: 1033225404
Provider Name (Legal Business Name): SUSAN ELIZABETH PHILLIPS PMHCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 W STATE ST STE M
ALLIANCE OH
44601-4686
US

IV. Provider business mailing address

625 CLEVELAND AVE NW
CANTON OH
44702-1805
US

V. Phone/Fax

Practice location:
  • Phone: 330-820-8407
  • Fax: 330-821-8506
Mailing address:
  • Phone: 330-455-0374
  • Fax: 330-453-6716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN 19977 / NS 01101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: