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General NPI Number Information
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NPI Number | 1518595859
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Entity Type | Individual
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Provider Name | KELLY PHILLIPS PHD
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Gender | Female
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 11400 W OLYMPIC BLVD STE 660
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City | LOS ANGELES
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State | CA
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Zip | 90064-1679
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Country | US
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Telephone | 310-935-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 5800 HANNUM AVE STE 105
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City | CULVER CITY
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State | CA
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Zip | 90230-6553
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Country | US
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Telephone | 310-410-9504
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 35802
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 35802
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35802
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 35802
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License Number State | CA
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