MEDICARE: MS. EMILIE NOEL PHILLIPS

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		MO

General Provider Information

NPI Number	:	1962045443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILIE NOEL PHILLIPS

Provider Business Mailing Address
First Line	:	3826 E LOMITA ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3710
Country	:	US
Telephone Number	:	417-827-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	3826 E LOMITA ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3710
Country	:	US
Telephone Number	:	417-827-5375
Fax Number	:

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

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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