Provider Demographics
NPI:1093945313
Name:PHILLIPS, SARA LEAH (MA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LEAH
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 1:812 N EDINBURGH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6938
Mailing Address - Country:US
Mailing Address - Phone:818-422-0195
Mailing Address - Fax:
Practice Address - Street 1:812 N EDINBURGH AVE APT 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-6938
Practice Address - Country:US
Practice Address - Phone:818-422-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health