Healthcare Provider Details

I. General information

NPI: 1770889693
Provider Name (Legal Business Name): YVETTE PHILLIPS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5553 S PEORIA AVE SUITE 106
TULSA OK
74105-6800
US

IV. Provider business mailing address

3329 W. FREEPORT ST.
BROKEN ARROW OK
74012
US

V. Phone/Fax

Practice location:
  • Phone: 918-852-4695
  • Fax:
Mailing address:
  • Phone: 918-851-1982
  • Fax:

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: