Provider Demographics
NPI:1104530500
Name:PHILLIPS-BEY, LATIA E
Entity type:Individual
Prefix:
First Name:LATIA
Middle Name:E
Last Name:PHILLIPS-BEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 SOUTH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1474
Mailing Address - Country:US
Mailing Address - Phone:216-970-7972
Mailing Address - Fax:
Practice Address - Street 1:695 SOUTH ST STE 6
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1474
Practice Address - Country:US
Practice Address - Phone:216-970-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical