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General NPI Number Information
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NPI Number | 1265817043
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Entity Type | Organization
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Legal Business Name | JANE PHILLIPS, PHD, LCSW & ASSOCIATES, PLLC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 4200 S HULEN ST SUITE 676
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City | FORT WORTH
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State | TX
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Zip | 76109-4914
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Country | US
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Telephone | 682-225-6990
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Fax | 817-732-3000
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Provider Business Mailing Address
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Address Line | 3909 PALUXY HWY
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City | GRANBURY
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State | TX
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Zip | 76048-5538
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Country | US
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Telephone | 682-225-6990
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Fax | 817-732-3000
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Authorized Official
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Title or Position | CEO
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Name | DR. JANE PHILLIPS
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Credential | LCSW
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Telephone | 682-225-6990
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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 | 34663
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License Number State | TX
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