Active NPI
Lisa Kristina Phillips, PH.D.
- Clinical Psychologist
- Costa Mesa, CA
National Provider Identifier
1790984078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY25324
- Practice address
- 151 Kalmus Dr Ste B220
Costa Mesa, CA 92626-7957 - Phone
- (949) 675-0545
- NPI assigned
- Jul 16, 2007
- Last updated
- Aug 4, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | |||
| Clinical Psychologist | 103TC0700X | PSY25324 | CA | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | |||
| Rehabilitation Practitioner | 225400000X |
Addresses
Primary practice location
151 Kalmus Dr Ste B220
Costa Mesa, CA 92626-7957
Mailing address
151 Kalmus Dr Ste B220
Costa Mesa, CA 92626-7957
Phone (949) 675-0545
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Oct 1, 2017 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25324 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| PSY25324 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375574400000",
"number": "1790984078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 KALMUS DR STE B220",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926267957",
"telephone_number": "949-675-0545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 KALMUS DR STE B220",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926267957",
"telephone_number": "949-675-0545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "LISA",
"middle_name": "KRISTINA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-16",
"last_updated": "2013-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY25324",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2013; 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.