Provider Demographics
NPI:1598551707
Name:PHILLIPS, MADISON BROOKE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:BROOKE
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SWN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-2558
Mailing Address - Country:US
Mailing Address - Phone:501-328-3274
Mailing Address - Fax:
Practice Address - Street 1:2323 W CHESTNUT ST STE 6
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3520
Practice Address - Country:US
Practice Address - Phone:479-346-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician