Provider Demographics
NPI:1225181282
Name:PHILLIPS, CHARI ROBERTA (MFT)
Entity type:Individual
Prefix:MRS
First Name:CHARI
Middle Name:ROBERTA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 ZANE CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5130
Mailing Address - Country:US
Mailing Address - Phone:702-456-4423
Mailing Address - Fax:702-435-9420
Practice Address - Street 1:5755 S SANDHILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2550
Practice Address - Country:US
Practice Address - Phone:702-458-4423
Practice Address - Fax:702-435-9420
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0504106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist