Provider Demographics
NPI:1720278567
Name:LEVY, PHYLLIS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PHYLLIS
Other - Middle Name:
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:8104 SUN MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1960
Mailing Address - Country:US
Mailing Address - Phone:817-346-3550
Mailing Address - Fax:817-568-1603
Practice Address - Street 1:8104 SUN MEADOWS CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1960
Practice Address - Country:US
Practice Address - Phone:817-346-3550
Practice Address - Fax:817-568-1603
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical