Provider Demographics
NPI:1730736026
Name:PHILLIPS, SARA MICHELE (APCC 15753)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELE
Last Name:PHILLIPS
Suffix:
Gender:
Credentials:APCC 15753
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23361 MADERO STE 210
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2715
Mailing Address - Country:US
Mailing Address - Phone:858-583-6188
Mailing Address - Fax:
Practice Address - Street 1:180 VIA VERDE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3993
Practice Address - Country:US
Practice Address - Phone:909-599-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPC15753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional