Provider Demographics
NPI:1871604058
Name:VANHEMERT, PHYLLIS BROWN (MED LPC)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:BROWN
Last Name:VANHEMERT
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LYTAL LANE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6910
Mailing Address - Country:US
Mailing Address - Phone:405-340-4446
Mailing Address - Fax:
Practice Address - Street 1:3855 SOUTH BOULEVARD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5499
Practice Address - Country:US
Practice Address - Phone:405-340-4321
Practice Address - Fax:405-340-9408
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1404101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional