MEDICARE: P K PHILLIPS LMFT, MA, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	147470	CA

General Provider Information

NPI Number	:	1285037424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	P K PHILLIPS LMFT, MA, MS

Provider Business Mailing Address
First Line	:	4231 BALBOA AVE # 1004
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:	808-280-7268
Fax Number	:

Provider Business Practice Location Address
First Line	:	4231 BALBOA AVE # 1004
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:	808-280-7268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	07/31/2024

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