Healthcare Provider Details

I. General information

NPI: 1396287488
Provider Name (Legal Business Name): TAMISA PHILLIPS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19069 VAN BUREN BLVD STE 114-457
RIVERSIDE CA
92508-9169
US

IV. Provider business mailing address

19069 VAN BUREN BLVD STE 114-457
RIVERSIDE CA
92508-9169
US

V. Phone/Fax

Practice location:
  • Phone: 818-514-4945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number205672
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: