Individual
DR. MICHAEL J PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
55 1ST PL NW, ISSAQUAH, WA 98027-3271
(425) 392-0277
(425) 392-2509
Mailing address
55 1ST PL NW, ISSAQUAH, WA 98027-3271
(425) 392-0277
(425) 392-2509
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY00001614
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4655971
AETNA US HEALTHCARE PIN
—
01
—
PH3914
REGENCE PIN
WA
Enumeration date
01/08/2007
Last updated
07/08/2007
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