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NPI Code Detail

MEDICARE: MRS. JAMIE DAWN PHILLIPS MS, LPC

MEDICARE:  MRS. JAMIE DAWN PHILLIPS  MS, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor2685OK

General Provider Information

NPI Number : 1093854556
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAMIE DAWN PHILLIPS MS, LPC
Provider Business Mailing Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 580-749-5056
Fax Number :
Provider Business Practice Location Address
First Line : 407 W SOUTH AVE
Second Line :
City : PONCA CITY
State : OK
Zip : 74601-6133
Country : US
Telephone Number : 918-549-8404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2007
Last Update Date : 01/26/2023

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