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General NPI Number Information
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NPI Number | 1508106048
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Entity Type | Organization
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Legal Business Name | PHASES COUNSELING & MENTAL HEALTH SERVICES, PLLC
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 04/26/2013
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Provider Practice Location Address
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Address Line | 5787 S HAMPTON RD STE 230-K
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City | DALLAS
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State | TX
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Zip | 75232-2255
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Country | US
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Telephone | 469-730-3360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1638
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City | DESOTO
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State | TX
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Zip | 75123-1638
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Country | US
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Telephone | 469-730-3360
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SONJA L. SHIPP
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Credential | LPC, LCDC
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Telephone | 469-730-3360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11144
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 65614
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License Number State | TX
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