Healthcare Provider Details

I. General information

NPI: 1053068130
Provider Name (Legal Business Name): COURTNEY LEEANN PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25925 BUDDE RD
SPRING TX
77380-2011
US

IV. Provider business mailing address

12071 COUNTY ROAD 201
PLANTERSVILLE TX
77363-1658
US

V. Phone/Fax

Practice location:
  • Phone: 281-465-4468
  • Fax:
Mailing address:
  • Phone: 210-347-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: