Provider Demographics
NPI:1912454752
Name:PHILLIPS, JOSIE J (LCSW)
Entity type:Individual
Prefix:MISS
First Name:JOSIE
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:GUTHRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:208-625-2070
Practice Address - Street 1:622 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ST. MARIES
Practice Address - State:ID
Practice Address - Zip Code:83837-2073
Practice Address - Country:US
Practice Address - Phone:208-245-4363
Practice Address - Fax:208-245-4349
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID406431041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical