Provider Demographics
NPI:1124048129
Name:PHILLIPS, BETTY L (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MASON CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2174
Mailing Address - Country:US
Mailing Address - Phone:530-666-4245
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3407
Practice Address - Country:US
Practice Address - Phone:530-666-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical