Individual
PHILLIP HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
253 S 2ND E BSMT, REXBURG, ID 83440-2202
(253) 232-3957
Mailing address
253 S 2ND E BSMT, REXBURG, ID 83440-2202
(253) 232-3957
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LMSW-38731
ID
Other
Enumeration date
06/13/2019
Last updated
06/13/2019
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