1396774568 NPI number — DR. MARSHA LYNN PHILIPS PSY.D.

Table of content: DR. MARSHA LYNN PHILIPS PSY.D. (NPI 1396774568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396774568 NPI number — DR. MARSHA LYNN PHILIPS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILIPS
Provider First Name:
MARSHA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396774568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 231142
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70183-1142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-734-8825
Provider Business Mailing Address Fax Number:
504-734-8826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1529 RIVER OAKS RD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARAHAN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70123-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-734-8825
Provider Business Practice Location Address Fax Number:
504-734-8826
Provider Enumeration Date:
07/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  599 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20765 . This is a "BCBS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 163405 . This is a "VALUE OPTIONS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2099762 . This is a "CIGNA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".