Provider Demographics
NPI:1437328978
Name:PHILLIPS, MICHELLE ARCHER (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ARCHER
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 FAIRHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5021
Mailing Address - Country:US
Mailing Address - Phone:805-231-8588
Mailing Address - Fax:
Practice Address - Street 1:333 FAIRHAVEN CT
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-5021
Practice Address - Country:US
Practice Address - Phone:805-231-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41807106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist