Provider Demographics
NPI:1356641955
Name:PHILLIPS, DOUGLAS AUSTIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:AUSTIN
Last Name:PHILLIPS
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 1:17600 YELLOW PINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHASTA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:96019-2074
Mailing Address - Country:US
Mailing Address - Phone:530-356-9133
Mailing Address - Fax:530-528-2938
Practice Address - Street 1:590 ANTELOPE BLVD
Practice Address - Street 2:B30
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2474
Practice Address - Country:US
Practice Address - Phone:530-529-9454
Practice Address - Fax:530-529-9456
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS117001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical