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General NPI Number Information
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NPI Number | 1801222120
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Entity Type | Organization
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Legal Business Name | PHILLIPS MEDSTONE A PSYCHOLOGICAL CORPORATION
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 5333 MISSION CENTER RD SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92108-1302
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Country | US
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Telephone | 619-543-0983
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Fax | 619-810-0383
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Provider Business Mailing Address
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Address Line | 5333 MISSION CENTER RD SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92108-1302
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Country | US
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Telephone | 619-543-0983
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Fax | 619-810-0383
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Authorized Official
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Title or Position | PRESIDENT
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Name | AUTUMN R PHILLIPS
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Credential | PSY D
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Telephone | 619-543-0983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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