Provider Demographics
NPI:1972673119
Name:PHILLIPS, NOELLE (CSW-PIP)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20324 VETERANS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3552
Mailing Address - Country:US
Mailing Address - Phone:402-933-5700
Mailing Address - Fax:402-829-8513
Practice Address - Street 1:20324 VETERANS DR STE 104
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3552
Practice Address - Country:US
Practice Address - Phone:402-933-5700
Practice Address - Fax:402-933-9998
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2115104100000X
SD1856104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100028290800Medicaid
NE1810OtherLICSW
NE2115OtherLIMHP
1856OtherLICENSE