Provider Demographics
NPI:1932296746
Name:CROW, PHYLLIS JEAN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:CROW
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 1:25501 CROWN VALLEY PKWY APT 373
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1195
Mailing Address - Country:US
Mailing Address - Phone:949-545-7040
Mailing Address - Fax:877-470-1892
Practice Address - Street 1:25501 CROWN VALLEY PKWY APT 373
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1195
Practice Address - Country:US
Practice Address - Phone:949-545-7040
Practice Address - Fax:877-470-1892
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC11751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist