Provider Demographics
NPI:1306300306
Name:PHILLIPS, AMY J (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 W CENTER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3138
Mailing Address - Country:US
Mailing Address - Phone:402-230-7222
Mailing Address - Fax:402-230-7131
Practice Address - Street 1:8424 W CENTER RD STE 203
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3138
Practice Address - Country:US
Practice Address - Phone:402-230-7222
Practice Address - Fax:402-230-7131
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11756101YM0800X
NE19681041C0700X
NE2522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA4094001Medicaid