Provider Demographics
NPI:1427155647
Name:WARREN H. PHILLIPS, III, PHD PC
Entity type:Organization
Organization Name:WARREN H. PHILLIPS, III, PHD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:515-222-1999
Mailing Address - Street 1:3737 WOODLAND AVE
Mailing Address - Street 2:SUITE 415
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1937
Mailing Address - Country:US
Mailing Address - Phone:515-222-1999
Mailing Address - Fax:515-224-3949
Practice Address - Street 1:3737 WOODLAND AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1937
Practice Address - Country:US
Practice Address - Phone:515-222-1999
Practice Address - Fax:515-224-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0047894Medicaid