Organization
FAITH L. PHILLIPS, PH.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAITH L PHILLIPS PH.D. (PSYCHOLOGIST)
(580) 584-5550
Entity
Organization
Contact information
Practice address
411 S. PARK DRIVE, BROKEN BOW, OK 74728-3331
(580) 584-5550
(866) 584-1223
Mailing address
411 S. PARK DRIVE, BROKEN BOW, OK 74728-3331
(580) 584-5550
(866) 584-1223
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
513
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200216630A
—
OK
Enumeration date
10/29/2008
Last updated
06/01/2012
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