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General NPI Number Information
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NPI Number | 1578757704
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Entity Type | Individual
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Provider Name | LORETTA ROSA PHIPPS LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 42413 BEAR LOOP DRIVE
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City | BIG BEAR LAKE
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State | CA
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Zip | 92315
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Country | US
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Telephone | 909-744-7852
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Fax | 760-690-3114
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Provider Business Mailing Address
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Address Line | PO BOX 2812
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City | BIG BEAR LAKE
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State | CA
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Zip | 92315-2812
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Country | US
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Telephone | 909-744-7852
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Fax | 760-690-3114
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 39982
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License Number State | CA
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