Provider Demographics
NPI:1083807440
Name:PHILLIPS, LAUREEN ANN (MA)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 FRANKLIN BLVD
Mailing Address - Street 2:STE. 1230
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-1820
Mailing Address - Country:US
Mailing Address - Phone:916-394-2010
Mailing Address - Fax:916-394-2011
Practice Address - Street 1:7000 FRANKLIN BLVD
Practice Address - Street 2:STE. 1230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1820
Practice Address - Country:US
Practice Address - Phone:916-394-2010
Practice Address - Fax:916-394-2011
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46571101YM0800X
CAMFC47328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health