Provider Demographics
NPI:1790259687
Name:PHILLIPS, ROSALYN ALEJO (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ROSALYN
Middle Name:ALEJO
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 6TH ST
Mailing Address - Street 2:PO BOX 1061
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702
Mailing Address - Country:US
Mailing Address - Phone:626-623-9157
Mailing Address - Fax:
Practice Address - Street 1:180 VIA VERDE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3993
Practice Address - Country:US
Practice Address - Phone:909-599-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110445106H00000X, 106H00000X
CA142179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist