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General NPI Number Information
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NPI Number | 1477837789
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Entity Type | Individual
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Provider Name | JEFFREY P PHILLIPS M.A.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 505 W 15TH
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City | PLEASANTON
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State | KS
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Zip | 66075-4095
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Country | US
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Telephone | 912-352-8214
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Fax | 913-352-8236
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Provider Business Mailing Address
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Address Line | PO BOX 807 304 N JEFFERSON AVE
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City | IOL
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State | KS
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Zip | 66749-2324
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Country | US
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Telephone | 620-365-8641
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Fax | 620-365-8642
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1427
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License Number State | KS
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