Provider Demographics
NPI:1689786048
Name:PHILLIPS, MARY HELOISE (MA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:HELOISE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2513
Mailing Address - Country:US
Mailing Address - Phone:530-223-2822
Mailing Address - Fax:530-223-1917
Practice Address - Street 1:3300 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2513
Practice Address - Country:US
Practice Address - Phone:530-223-2822
Practice Address - Fax:530-223-1917
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 21827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist