Provider Demographics
NPI:1104162775
Name:PHILLIPS, ANDREA DANA LEE (LPC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DANA LEE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LEE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 PEARL STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1241
Mailing Address - Country:US
Mailing Address - Phone:417-781-4552
Mailing Address - Fax:
Practice Address - Street 1:707 PEARL STREET
Practice Address - Street 2:SUITE B
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1241
Practice Address - Country:US
Practice Address - Phone:417-781-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012037385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional