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General NPI Number Information
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NPI Number | 1003727686
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Entity Type | Individual
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Provider Name | KE'NIYAH PHILLIPS LAC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 3302 E MOORE AVE OFC 5
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City | SEARCY
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State | AR
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Zip | 72143-5099
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Country | US
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Telephone | 501-230-0130
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Fax | 501-300-9689
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Provider Business Mailing Address
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Address Line | 350 SALEM RD STE 10
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City | CONWAY
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State | AR
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Zip | 72034-7525
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Country | US
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Telephone | 501-336-8300
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Fax | 501-329-6166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2608009
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License Number State | AR
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