Provider Demographics
NPI:1790014488
Name:PHILLIPS, AMY LYNN (LCPC, LMHC, EDD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCPC, LMHC, EDD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:AUGUST
Other - Last Name:CAHANIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LMHC, EDD
Mailing Address - Street 1:12527 NW FOREST SPRING LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9360
Mailing Address - Country:US
Mailing Address - Phone:202-424-9616
Mailing Address - Fax:
Practice Address - Street 1:3509 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-3934
Practice Address - Country:US
Practice Address - Phone:301-755-9469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654736Medicaid