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NPI Code Detail

MEDICARE: JOCLYN PHILLIPS

MEDICARE:   JOCLYN  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
1102L00000XPsychoanalystNV

General Provider Information

NPI Number : 1962814707
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOCLYN PHILLIPS
Provider Business Mailing Address
First Line : 5717 RED ROOF ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-2440
Country : US
Telephone Number : 612-309-7531
Fax Number :
Provider Business Practice Location Address
First Line : 5717 RED ROOF ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-2440
Country : US
Telephone Number : 612-309-7531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2014
Last Update Date : 05/28/2014

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Directions to “ JOCLYN PHILLIPS ” Practice Location

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