Provider Demographics
NPI:1225607310
Name:PHILLIPS-YOUNG, SHONDA LAVON (LCSW-S)
Entity type:Individual
Prefix:
First Name:SHONDA
Middle Name:LAVON
Last Name:PHILLIPS-YOUNG
Suffix:
Gender:
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 301
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9147
Mailing Address - Country:US
Mailing Address - Phone:254-599-8181
Mailing Address - Fax:254-213-4200
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 301
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9147
Practice Address - Country:US
Practice Address - Phone:254-599-8181
Practice Address - Fax:254-213-4200
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX649611041C0700X
FLTPSW49101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical