Healthcare Provider Details

I. General information

NPI: 1871770065
Provider Name (Legal Business Name): RINA A PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 CHICKASAW DR. OUTPATIENT SERVICES-ARDMORE STRONG FAMILY DEVELOPMENT:
ARDMORE OK
73401
US

IV. Provider business mailing address

210 E MAIN RESOURCE MANAGEMENT
ADA OK
74820
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-8181
  • Fax: 405-858-2720
Mailing address:
  • Phone: 580-436-7211
  • Fax: 580-272-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: