Basic Information
| Provider Information | |||||||||
| NPI: | 1992923056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAPIA | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 NORTHGATE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949033696 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154576964 | ||||||||
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| Practice Location | |||||||||
| Address1: | 114 SOUTH E STREET SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075718452 | ||||||||
| FaxNumber: | 7075715531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | CA | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 1704 | 01 | CA | COUNSELOR | OTHER |