Provider Demographics
NPI:1588871818
Name:PHILLIPS, STEPHEN GLENN (LCSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GLENN
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 LAKEVIEW DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7958
Mailing Address - Country:US
Mailing Address - Phone:863-385-9611
Mailing Address - Fax:863-385-9711
Practice Address - Street 1:1570 LAKEVIEW DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7958
Practice Address - Country:US
Practice Address - Phone:863-385-9611
Practice Address - Fax:863-385-9711
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW35251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical