Provider Demographics
NPI:1528202207
Name:SPRADLING, PHILIP V (MFT INTERN)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:V
Last Name:SPRADLING
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N OAKLAND AVE
Mailing Address - Street 2:#206
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1444
Mailing Address - Country:US
Mailing Address - Phone:626-396-5920
Mailing Address - Fax:
Practice Address - Street 1:2046 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3424
Practice Address - Country:US
Practice Address - Phone:626-396-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA59828101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health