Provider Demographics
NPI:1598083909
Name:PHILLIPS, AUTUMN ROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:ROSE
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 1:7592 METROPOLITAN DR
Mailing Address - Street 2:STE 400
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4428
Mailing Address - Country:US
Mailing Address - Phone:877-727-5974
Mailing Address - Fax:877-728-3404
Practice Address - Street 1:7592 METROPOLITAN DR
Practice Address - Street 2:STE 400
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4428
Practice Address - Country:US
Practice Address - Phone:877-727-5974
Practice Address - Fax:877-728-3404
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist