Healthcare Provider Details

I. General information

NPI: 1568383099
Provider Name (Legal Business Name): NATASHA LOUISE PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S AIR DEPOT BLVD
MIDWEST CITY OK
73110-5103
US

IV. Provider business mailing address

21153 RIVER MIST DR
HARRAH OK
73045-5013
US

V. Phone/Fax

Practice location:
  • Phone: 405-622-4239
  • Fax:
Mailing address:
  • Phone: 405-622-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828780
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: