Provider Demographics
NPI:1144231986
Name:COHEN, PHILLIP THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:THOMAS
Last Name:COHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25401 CABOT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5524
Mailing Address - Country:US
Mailing Address - Phone:949-951-3003
Mailing Address - Fax:949-951-8586
Practice Address - Street 1:25401 CABOT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5524
Practice Address - Country:US
Practice Address - Phone:949-951-3003
Practice Address - Fax:949-951-8586
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91385Medicare UPIN