Stephen Conwell Phillips, J.D., PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY17868 Issued in CA

Practice address

9171 Wilshire Blvd
Suite 350a
Beverly Hills, CA 90210-5530

Phone

(310) 275-4194

Fax

(310) 788-0988

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 22, 2015 through Oct 22, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Juris Doctor

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263859200000",
    "number": "1417000613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 S BEVERLY DR",
            "address_2": "PMB NO. 323",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902123851",
            "telephone_number": "310-275-4194",
            "fax_number": "310-788-0988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9171 WILSHIRE BLVD",
            "address_2": "SUITE 350A",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105530",
            "telephone_number": "310-275-4194",
            "fax_number": "310-788-0988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "STEPHEN",
        "middle_name": "CONWELL",
        "name_prefix": "Dr.",
        "credential": "J.D., PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2010-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17868",
            "primary": true
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "CA",
            "license": "PSY17868",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.