MEDICARE: MS. MARINDA DAWN PHILLIPS BCBA

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

General Provider Information

NPI Number	:	1831363969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARINDA DAWN PHILLIPS BCBA

Provider Business Mailing Address
First Line	:	2916 PARK VALLEY DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-7139
Country	:	US
Telephone Number	:	731-695-4070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2916 PARK VALLEY DR
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-7139
Country	:	US
Telephone Number	:	731-695-4070
Fax Number	:

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

Provider Enumeration Date	:	04/18/2008
Last Update Date	:	04/18/2008

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