1629154588 NPI number — ROSE STEEG PHILLIPS MA, LMFT

Table of content: ROSE STEEG PHILLIPS MA, LMFT (NPI 1629154588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629154588 NPI number — ROSE STEEG PHILLIPS MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
ROSE
Provider Middle Name:
STEEG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
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:
1629154588
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2280 SANDIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86301-5308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-717-2505
Provider Business Mailing Address Fax Number:
928-717-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 CLEARWATER DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-717-2505
Provider Business Practice Location Address Fax Number:
928-717-2504
Provider Enumeration Date:
10/31/2006

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: 106H00000X , with the licence number:  LMFT 10202 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 960973 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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