Provider Demographics
NPI:1326730441
Name:PHILLIPS, ANGELA PATRICIA (AMFT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:PATRICIA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:PATRICIA
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 JOANN ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6455
Mailing Address - Country:US
Mailing Address - Phone:949-426-6446
Mailing Address - Fax:
Practice Address - Street 1:250 JOANN ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-6455
Practice Address - Country:US
Practice Address - Phone:949-426-6446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist