Provider Demographics
NPI:1528068707
Name:SOCAL BEHAVIORAL HEALTH PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SOCAL BEHAVIORAL HEALTH PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-453-0688
Mailing Address - Street 1:601 PARKCENTER DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3522
Mailing Address - Country:US
Mailing Address - Phone:714-453-0688
Mailing Address - Fax:714-453-0691
Practice Address - Street 1:601 PARKCENTER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3522
Practice Address - Country:US
Practice Address - Phone:714-453-0688
Practice Address - Fax:714-453-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27807872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALICENSE # 2780787OtherSTATE LICENSE #
CAZZZ65665ZOtherBLUE SHIELD OF CA
CAGR0100750Medicaid
CAZZZ65665ZOtherBLUE SHIELD OF CA
CAZZZ65665ZOtherBLUE SHIELD OF CA