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Organization
SOCAL BEHAVIORAL HEALTH PROFESSIONAL CORPORATION
Active
Organization
SOCAL BEHAVIORAL HEALTH PROFESSIONAL CORPORATION
Active
Other names
SoCal Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEOFFREY B. PHILLIPS M.D. (PRESIDENT)
(714) 453-0688
Entity
Organization
Contact information
Practice address
601 PARKCENTER DR, SUITE 206, SANTA ANA, CA 92705-3522
(714) 453-0688
(714) 453-0691
Mailing address
601 PARKCENTER DR, SUITE 206, SANTA ANA, CA 92705-3522
(714) 453-0688
(714) 453-0691
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2780787
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0100750
—
CA
01
—
LICENSE # 2780787
STATE LICENSE #
CA
01
—
ZZZ65665Z
BLUE SHIELD OF CA
CA
Enumeration date
07/28/2005
Last updated
08/17/2018
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