Provider Demographics
NPI:1134320765
Name:HANGER, PHILIP A (PHD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:HANGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:
Other - Last Name:HANGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3255 CAMINO DEL RIO S
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13403 N GOVERNMENT WAY UNIT 215
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8900
Practice Address - Country:US
Practice Address - Phone:208-889-5053
Practice Address - Fax:208-567-4157
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202760103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical