Provider Demographics
NPI:1417000613
Name:PHILLIPS, STEPHEN CONWELL (JD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CONWELL
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:JD, PSYD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:269 S BEVERLY DR
Mailing Address - Street 2:PMB NO. 323
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3851
Mailing Address - Country:US
Mailing Address - Phone:310-275-4194
Mailing Address - Fax:310-788-0988
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:SUITE 350A
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-275-4194
Practice Address - Fax:310-788-0988
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY17868103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic