Provider Demographics
NPI:1861801961
Name:PHILLIPS, MEGAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7978 E CHRISTOPHER CT
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1564
Mailing Address - Country:US
Mailing Address - Phone:650-804-4263
Mailing Address - Fax:
Practice Address - Street 1:2230 W CHAPMAN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2316
Practice Address - Country:US
Practice Address - Phone:650-804-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist