=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053444604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILLIPS AGENCY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 532 BRYDEN AVE
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83501-4445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-746-7266
-----------------------------------------------------
Fax | 208-798-5169
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 532 BRYDEN AVE
-----------------------------------------------------
City | LEWISTON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83501-4445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-746-7266
-----------------------------------------------------
Fax | 208-798-5169
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JAMES R PHILLIPS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 208-746-7266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY-305
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | LCPC-144
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------