MEDICARE: DR. ERICA JACOBSEN PHILLIPS PSY.D.

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	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	PY0943	NV

General Provider Information

NPI Number	:	1154638971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA JACOBSEN PHILLIPS PSY.D.

Provider Business Mailing Address
First Line	:	10731 MORNING FROST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-1301
Country	:	US
Telephone Number	:	360-791-8823
Fax Number	:

Provider Business Practice Location Address
First Line	:	10731 MORNING FROST ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89179-1301
Country	:	US
Telephone Number	:	360-791-8823
Fax Number	:

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	02/08/2021

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