Provider Demographics
NPI:1689692832
Name:ONCLEY, PHILIP R (PHD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:ONCLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 90125
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-0125
Mailing Address - Country:US
Mailing Address - Phone:562-598-8558
Mailing Address - Fax:562-795-0676
Practice Address - Street 1:5212 KATELLA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2828
Practice Address - Country:US
Practice Address - Phone:562-430-7986
Practice Address - Fax:562-493-1684
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13762103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY137620Medicaid
CAR15543Medicare UPIN
CAPSY137620Medicaid