Provider Demographics
NPI:1528640919
Name:PHILLIPS, LAURA ELIZABETH
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35896 WILDHORSE RD
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-2770
Mailing Address - Country:US
Mailing Address - Phone:918-647-6849
Mailing Address - Fax:
Practice Address - Street 1:204 WALL ST STE A
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-4400
Practice Address - Country:US
Practice Address - Phone:918-649-0018
Practice Address - Fax:918-564-2744
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor