Healthcare Provider Details

I. General information

NPI: 1124421326
Provider Name (Legal Business Name): JOVAN PHILLIPS BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 LAKEVIEW HAVEN DR STE 100
HOUSTON TX
77095-2694
US

IV. Provider business mailing address

7050 LAKEVIEW HAVEN DR STE 100
HOUSTON TX
77095-2694
US

V. Phone/Fax

Practice location:
  • Phone: 346-946-5563
  • Fax: 346-209-2029
Mailing address:
  • Phone: 346-946-5563
  • Fax: 346-946-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: