# FAITH L. PHILLIPS, PH.D., PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104079474
- **Authorized official:** DR. FAITH L PHILLIPS PH.D. (PSYCHOLOGIST)
- **Authorized official phone:** (580) 584-5550

## Contact information

- **Practice address:** 411 S. PARK DRIVE, BROKEN BOW, OK 74728-3331
- **Practice address phone:** (580) 584-5550
- **Practice address fax:** (866) 584-1223
- **Mailing address:** 411 S. PARK DRIVE, BROKEN BOW, OK 74728-3331
- **Mailing address phone:** (580) 584-5550
- **Mailing address fax:** (866) 584-1223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | 513 | OK | Yes |

## Other

- **Enumeration date:** 10/29/2008
- **Last updated:** 06/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200216630A | — | OK |