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General NPI Number Information
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NPI Number | 1245017474
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Entity Type | Individual
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Provider Name | MICHAEL DAVID PHILLIPS LICSW
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Gender | Male
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 3066 MOUNT CHARLESTON DR
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City | PAHRUMP
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State | NV
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Zip | 89048-1048
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Country | US
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Telephone | 336-883-5543
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Fax |
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Provider Business Mailing Address
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Address Line | 3066 MOUNT CHARLESTON DR
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City | PAHRUMP
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State | NV
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Zip | 89048-1048
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Country | US
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Telephone | 336-883-5543
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SWI.LW.61502192
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License Number State | WA
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