Provider Demographics
NPI:1649472911
Name:PHILIPS, SARAH KASHAM
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KASHAM
Last Name:PHILIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12352 RUTHERFORD DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8871
Mailing Address - Country:US
Mailing Address - Phone:909-463-2541
Mailing Address - Fax:
Practice Address - Street 1:12352 RUTHERFORD DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8871
Practice Address - Country:US
Practice Address - Phone:909-463-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist