Provider Demographics
NPI:1851480172
Name:PHILLIPS, LEONA KAY (LMFT,MA,PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONA
Middle Name:KAY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMFT,MA,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-0447
Mailing Address - Country:US
Mailing Address - Phone:209-419-1322
Mailing Address - Fax:209-296-8792
Practice Address - Street 1:16 BRYSON DR
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4118
Practice Address - Country:US
Practice Address - Phone:209-419-1322
Practice Address - Fax:209-296-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15635106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851480172OtherNPI