Provider Demographics
NPI:1699476655
Name:PHILLIPS, KIMBERLI SHEA (PHD, LCSW, ACHP-SW)
Entity type:Individual
Prefix:DR
First Name:KIMBERLI
Middle Name:SHEA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHD, LCSW, ACHP-SW
Other - Prefix:
Other - First Name:KIMBERLI
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5211 SW 9TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4197
Mailing Address - Country:US
Mailing Address - Phone:806-356-0026
Mailing Address - Fax:806-358-3114
Practice Address - Street 1:5211 SW 9TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4197
Practice Address - Country:US
Practice Address - Phone:806-356-0026
Practice Address - Fax:806-358-3114
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX382701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical