Individual
PHYLLIS OTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSAT
Contact information
Practice address
205 E OSBORN RD, PHOENIX, AZ 85012-2327
(833) 445-3711
Mailing address
205 E OSBORN RD, PHOENIX, AZ 85012-2327
(833) 445-3711
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LSAT-15163
AZ
Other
Enumeration date
08/19/2024
Last updated
08/19/2024
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