Provider Demographics
NPI:1891431938
Name:PHILLIPS, SARA KATE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KATE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 RALEIGH ST APT 326
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1386
Mailing Address - Country:US
Mailing Address - Phone:207-272-3255
Mailing Address - Fax:
Practice Address - Street 1:1550 RALEIGH ST APT 326
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1386
Practice Address - Country:US
Practice Address - Phone:207-272-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-113965106S00000X
1-23-65660103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-23-65660OtherBACB, BCBA NUMBER