MEDICARE: JOVAN PHILLIPS BCBA, LBA

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
1	103K00000X	Behavior Analyst	1898	TX

General Provider Information

NPI Number	:	1124421326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOVAN PHILLIPS BCBA, LBA

Provider Business Mailing Address
First Line	:	7050 LAKEVIEW HAVEN DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2694
Country	:	US
Telephone Number	:	346-946-5563
Fax Number	:	346-946-5563

Provider Business Practice Location Address
First Line	:	7050 LAKEVIEW HAVEN DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-2694
Country	:	US
Telephone Number	:	346-946-5563
Fax Number	:	346-209-2029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2014
Last Update Date	:	08/12/2024

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