MEDICARE: DALISHA CHEREE PHILLIPS LMHCA, ATR-P

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	221700000X	Art Therapist	19-458	WA
2	101YM0800X	Mental Health Counselor	MHCA.MC.60914693	WA

General Provider Information

NPI Number	:	1659918027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALISHA CHEREE PHILLIPS LMHCA, ATR-P

Provider Business Mailing Address
First Line	:	212 BROADWAY E # 22111
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-7032
Country	:	US
Telephone Number	:	253-260-6139
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 23RD AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4859
Country	:	US
Telephone Number	:	253-260-6139
Fax Number	:

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

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/04/2019

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