Provider Demographics
NPI:1023637592
Name:PHILLIPS, NATALIE MOSES (LPC)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:MOSES
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:GAIL
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:ORANGE GROVE
Mailing Address - State:TX
Mailing Address - Zip Code:78372-0349
Mailing Address - Country:US
Mailing Address - Phone:210-401-3896
Mailing Address - Fax:
Practice Address - Street 1:413 E ORANGE AVE # 349
Practice Address - Street 2:
Practice Address - City:ORANGE GROVE
Practice Address - State:TX
Practice Address - Zip Code:78372-3699
Practice Address - Country:US
Practice Address - Phone:210-401-3896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional