Provider Demographics
NPI:1508001744
Name:PHILLIPS, JANET LYNNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:LYNNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 943
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-0943
Mailing Address - Country:US
Mailing Address - Phone:916-960-6045
Mailing Address - Fax:916-315-8501
Practice Address - Street 1:6000 FAIRWAY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4244
Practice Address - Country:US
Practice Address - Phone:916-960-6045
Practice Address - Fax:916-315-8501
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22226103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical