Healthcare Provider Details

I. General information

NPI: 1184186165
Provider Name (Legal Business Name): MS. LAURIAN ELIZABETH PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2489 TAPO ST UNIT B
SIMI VALLEY CA
93063-2453
US

IV. Provider business mailing address

5231 DRIFTWOOD ST
OXNARD CA
93035-1016
US

V. Phone/Fax

Practice location:
  • Phone: 818-554-2600
  • Fax:
Mailing address:
  • Phone: 805-908-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW85668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: