| Faith L. Phillips, Ph.d., Pllc | |
|
411 S. Park Drive Broken Bow OK 74728-3331 | |
| (580) 584-5550 | |
| (866) 584-1223 |
| Full Name | Faith L. Phillips, Ph.d., Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 411 S. Park Drive, Broken Bow, Oklahoma |
| Authorized Official Name and Position | Faith L Phillips (PSYCHOLOGIST) |
| Authorized Official Contact | 5805845550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Faith L. Phillips, Ph.d., Pllc 411 S. Park Drive Broken Bow OK 74728-3331 Ph: (580) 584-5550 | Faith L. Phillips, Ph.d., Pllc 411 S. Park Drive Broken Bow OK 74728-3331 Ph: (580) 584-5550 |
| NPI Number | 1104079474 |
|---|---|
| Provider Enumeration Date | 10/29/2008 |
| Last Update Date | 06/01/2012 |
| Medicare PECOS PAC ID | 2466793518 |
|---|---|
| Medicare Enrollment ID | O20190418000319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104079474 | NPI | - | NPPES |
| 200216630A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 513 (Oklahoma) | Primary |
| Provider Name | Faith Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699925867 PECOS PAC ID: 1456692508 Enrollment ID: I20190418000408 |
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