Provider Demographics
NPI:1144668575
Name:DEMING, PHILLIP ROSS (LMFT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ROSS
Last Name:DEMING
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-0355
Mailing Address - Country:US
Mailing Address - Phone:619-252-5221
Mailing Address - Fax:
Practice Address - Street 1:18655 BERNARDO CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127
Practice Address - Country:US
Practice Address - Phone:619-252-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist