Provider Demographics
NPI:1316917628
Name:PHILLIPS, HANNAH M (MD)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 22664
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221
Mailing Address - Country:US
Mailing Address - Phone:501-225-4556
Mailing Address - Fax:501-225-4556
Practice Address - Street 1:11219 FINANCIAL CENTRE PARKWAY
Practice Address - Street 2:SUITE 314
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-221-9966
Practice Address - Fax:501-221-3675
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC-7136OtherLICENSE NUMBER
AR114197001Medicaid
AR114197001Medicaid
ARC-7136OtherLICENSE NUMBER