Provider Demographics
NPI:1285037424
Name:PHILLIPS, P K (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:P K
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 E DODGE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6730
Mailing Address - Country:US
Mailing Address - Phone:808-280-7268
Mailing Address - Fax:
Practice Address - Street 1:1660 HOTEL CIR N STE 314
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2803
Practice Address - Country:US
Practice Address - Phone:619-759-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107505106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist