Basic Information
| Provider Information | |||||||||
| NPI: | 1083807440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIPS | ||||||||
| FirstName: | LAUREEN | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 FRANKLIN BLVD | ||||||||
| Address2: | STE. 1230 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958231820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163942010 | ||||||||
| FaxNumber: | 9163942011 | ||||||||
| Practice Location | |||||||||
| Address1: | 7000 FRANKLIN BLVD | ||||||||
| Address2: | STE. 1230 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958231820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163942010 | ||||||||
| FaxNumber: | 9163942011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2007 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 46571 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MFC47328 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.