Provider Demographics
NPI:1164789491
Name:GABLE, PHILLIP (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:GABLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26001 REDLANDS BLVD.
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7782
Mailing Address - Country:US
Mailing Address - Phone:909-583-6987
Mailing Address - Fax:
Practice Address - Street 1:26001 REDLANDS BLVD.
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7782
Practice Address - Country:US
Practice Address - Phone:909-583-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4285103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical