Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 00842 | IA |
N | 103T00000X | Psychologist | 00842 | IA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 00842 | IA |
N | 103G00000X | Clinical Psychologist | 00842 | IA |
N | 103TC0700X | Clinical Psychologist | 00842 | IA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 00842 | IA |
Y | 103TH0100X | Health Service | 356 | IA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 00842 | IA |
NPI | 1083705917 |
---|---|
Provider Name | Dr. Warren H Phillips |
First Address | Ames, IA 50010-6974 |
Second Address | Ames, IA 50010-6974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 15/01/2021 |