Provider Demographics
NPI:1104183292
Name:SOCAL CENTER FOR CHANGE
Entity Type:Organization
Organization Name:SOCAL CENTER FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-453-0688
Mailing Address - Street 1:1110 E CHAPMAN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2139
Mailing Address - Country:US
Mailing Address - Phone:714-453-0688
Mailing Address - Fax:714-453-0691
Practice Address - Street 1:1110 E CHAPMAN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2139
Practice Address - Country:US
Practice Address - Phone:714-453-0688
Practice Address - Fax:714-453-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty