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General NPI Number Information
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NPI Number | 1285874255
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Entity Type | Organization
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Legal Business Name | PHILLIPS GRADUATE UNIVERSITY
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 19900 PLUMMER ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-5541
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Country | US
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Telephone | 818-907-9980
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Fax | 818-386-5694
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Provider Business Mailing Address
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Address Line | 19900 PLUMMER STREET
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City | CHATSWORTH
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State | CA
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Zip | 91311
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Country | US
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Telephone | 818-907-9980
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Fax | 818-386-5694
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | RANDY CHRISTOPHER
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Credential | LMFT
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Telephone | 818-386-5612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State | CA
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