Provider Demographics
NPI:1184409435
Name:PHILLIPS, KIMBERLY LAVENDER (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAVENDER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5804
Mailing Address - Country:US
Mailing Address - Phone:214-675-7552
Mailing Address - Fax:
Practice Address - Street 1:1910 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-4529
Practice Address - Country:US
Practice Address - Phone:214-643-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104010104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker