Healthcare Provider Details

I. General information

NPI: 1508183591
Provider Name (Legal Business Name): RACHAEL RENEE PHILLIPS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENEE PHILLIPS PH.D.

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

5547 LEDGESONE
DALLAS TX
75214-2025
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-2669
  • Fax: 214-820-9606
Mailing address:
  • Phone: 214-820-2669
  • Fax: 214-820-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34355
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: