Healthcare Provider Details

I. General information

NPI: 1801703574
Provider Name (Legal Business Name): ALYSSA PHILLIPS AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W MAIN ST STE 103
TUSTIN CA
92780-7712
US

IV. Provider business mailing address

8064 ALLISON AVE UNIT 31
LA MESA CA
91944-6903
US

V. Phone/Fax

Practice location:
  • Phone: 714-869-1639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: