Healthcare Provider Details

I. General information

NPI: 1144729690
Provider Name (Legal Business Name): CARRIE S PHILLIPS, FAMILY THERAPIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SAXONY RD STE 203
ENCINITAS CA
92024-6780
US

IV. Provider business mailing address

PO BOX 230339
ENCINITAS CA
92023-0339
US

V. Phone/Fax

Practice location:
  • Phone: 760-230-9050
  • Fax: 760-239-9700
Mailing address:
  • Phone: 760-230-9050
  • Fax: 760-239-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number950340
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number50096
License Number StateCA

VIII. Authorized Official

Name: CARRIE SUZANNE PHILLIPS
Title or Position: CEO/OWNER
Credential: MFT, RD
Phone: 760-230-9050