Provider Demographics
NPI:1265777247
Name:PHILLIPS, DAVID BROOKS (LMFT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BROOKS
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 N ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-4240
Mailing Address - Country:US
Mailing Address - Phone:916-833-2283
Mailing Address - Fax:
Practice Address - Street 1:2023 N ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-4240
Practice Address - Country:US
Practice Address - Phone:916-833-2283
Practice Address - Fax:916-833-2283
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist