Provider Demographics
NPI:1306178512
Name:PERCY, PHILLIP M (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:PERCY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 N WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7161
Mailing Address - Country:US
Mailing Address - Phone:951-907-5279
Mailing Address - Fax:
Practice Address - Street 1:2206 N WRIGHT ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7161
Practice Address - Country:US
Practice Address - Phone:951-907-5279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS172701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical