Provider Demographics
NPI:1144496118
Name:PHILLIPS, SAMUEL EVERETT IV (BA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EVERETT
Last Name:PHILLIPS
Suffix:IV
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 W HERNDON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0552
Mailing Address - Country:US
Mailing Address - Phone:559-256-2000
Mailing Address - Fax:559-256-3000
Practice Address - Street 1:1470 W HERNDON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0552
Practice Address - Country:US
Practice Address - Phone:559-256-2000
Practice Address - Fax:559-256-3000
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor