Provider Demographics
NPI:1992114276
Name:DR. SUSAN P. PHILLIPS, PH.D. LLC
Entity type:Organization
Organization Name:DR. SUSAN P. PHILLIPS, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-997-4538
Mailing Address - Street 1:2824 WINDGUARD CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7369
Mailing Address - Country:US
Mailing Address - Phone:813-997-4538
Mailing Address - Fax:813-991-7584
Practice Address - Street 1:2824 WINDGUARD CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7369
Practice Address - Country:US
Practice Address - Phone:813-997-4538
Practice Address - Fax:813-991-7584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7291103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHD093AOtherMEDICARE PTAN