MEDICARE: DR. SUSAN P. PHILLIPS, PH.D. LLC

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	103TC1900X	Counseling Psychologist	PY7291	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HD093A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1992114276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SUSAN P. PHILLIPS, PH.D. LLC

Provider Business Mailing Address
First Line	:	2824 WINDGUARD CIR
Second Line	:	SUITE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7369
Country	:	US
Telephone Number	:	813-997-4538
Fax Number	:	813-991-7584

Provider Business Practice Location Address
First Line	:	2824 WINDGUARD CIR
Second Line	:	SUITE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7369
Country	:	US
Telephone Number	:	813-997-4538
Fax Number	:	813-991-7584

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. SUSAN P PHILLIPS
Credential	:	PH.D.
Telephone Number	:	813-997-4538

Provider Enumeration Date	:	08/12/2014
Last Update Date	:	03/03/2015

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