Provider Demographics
NPI:1124151378
Name:PHILLIPS, PATSY DANE (MED LPC LMFT)
Entity type:Individual
Prefix:MS
First Name:PATSY
Middle Name:DANE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MED LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 MYERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244
Mailing Address - Country:US
Mailing Address - Phone:972-239-2015
Mailing Address - Fax:972-239-1039
Practice Address - Street 1:4708 MYERWOOD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244
Practice Address - Country:US
Practice Address - Phone:972-479-9803
Practice Address - Fax:972-239-1039
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3034101YP2500X
TX2289106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1384LCOtherBLUE CROSS BLUE SHIELD