Provider Demographics
NPI:1699085282
Name:PHILLIPS, BRIGETTE DEANN (CDP)
Entity type:Individual
Prefix:
First Name:BRIGETTE
Middle Name:DEANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:BRIGETTE
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17704 W OIE HWY
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-9532
Mailing Address - Country:US
Mailing Address - Phone:509-221-8402
Mailing Address - Fax:
Practice Address - Street 1:17704 W OIE HWY
Practice Address - Street 2:
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320-9532
Practice Address - Country:US
Practice Address - Phone:509-221-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60215842101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)