Healthcare Provider Details

I. General information

NPI: 1215899307
Provider Name (Legal Business Name): MR. PHILIP KEITH LITTMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 KIPLING DR
CARMICHAEL CA
95608-6226
US

IV. Provider business mailing address

4830 KIPLING DR
CARMICHAEL CA
95608-6226
US

V. Phone/Fax

Practice location:
  • Phone: 916-718-5694
  • Fax:
Mailing address:
  • Phone: 916-718-5694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLF10466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: