MEDICARE: HEATHER PHILLIPS LMFT

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	101Y00000X	Counselor	99112912A	IN

General Provider Information

NPI Number	:	1417667940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER PHILLIPS LMFT

Provider Business Mailing Address
First Line	:	3201 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4697
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4697
Country	:	US
Telephone Number	:	215-645-2084
Fax Number	:

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

Provider Enumeration Date	:	11/23/2022
Last Update Date	:	03/19/2026

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Directions to “ HEATHER PHILLIPS LMFT” Practice Location

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