Individual
DR. FAITH LUCILLE PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
411 S. PARK DRIVE, BROKEN BOW, OK 74728
(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
103TC0700X
Clinical Psychologist
513
OK
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
513
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100837660A
—
OK
Enumeration date
09/24/2008
Last updated
07/25/2018
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