Individual
MS. MARY PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., L.P.
Contact information
Practice address
633 MAIN ST NW APT 220, ELK RIVER, MN 55330-1792
(612) 422-0890
Mailing address
633 MAIN ST NW APT 220, ELK RIVER, MN 55330-1792
(612) 422-0890
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 4021
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
877934100
MHCP
MN
Enumeration date
11/20/2006
Last updated
02/12/2022
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