Provider Demographics
NPI:1124421326
Name:PHILLIPS, JOVAN (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JOVAN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 LAKEVIEW HAVEN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2694
Mailing Address - Country:US
Mailing Address - Phone:346-946-5563
Mailing Address - Fax:346-946-5563
Practice Address - Street 1:7050 LAKEVIEW HAVEN DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2694
Practice Address - Country:US
Practice Address - Phone:346-946-5563
Practice Address - Fax:346-209-2029
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1898103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst