Provider Demographics
NPI:1760246326
Name:PHILLIPS, JORDYN (RBT)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-428 MOKUOLA ST STE 214A
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:94-428 MOKUOLA ST STE 214A
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3396
Practice Address - Country:US
Practice Address - Phone:470-241-1353
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GARBT-23-277802106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician