Individual
MR. RICHARD WAYNE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
1480 ERIN CT, EUREKA, CA 95503-6175
(707) 497-6749
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT26065
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT26065
BVNPTE
CA
Enumeration date
08/05/2008
Last updated
08/05/2008
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