Provider Demographics
NPI:1417134339
Name:PHILIPS, ALICE (MFT)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 REDWOOD RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4313
Mailing Address - Country:US
Mailing Address - Phone:510-318-0433
Mailing Address - Fax:510-430-2434
Practice Address - Street 1:20200 REDWOOD RD
Practice Address - Street 2:SUITE 9
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4313
Practice Address - Country:US
Practice Address - Phone:510-318-0433
Practice Address - Fax:510-430-2434
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist