MR. PHILLIP SHACK UTUMAPU RAS NPI 1962834721

NPI Information

NPI: 1962834721
Provider Name: MR. PHILLIP SHACK UTUMAPU, RAS
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
13626 HOLMES ST APT 16
YUCAIPA, CA
ZIP 92399
Phone: (760) 619-0663
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MR. Phillip Shack Utumapu, RAS is an addiction (substance use disorder) counselor in Yucaipa, CA. MR. Phillip Shack Utumapu, RAS NPI is 1962834721. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

13626 HOLMES ST APT 16
YUCAIPA, CA
ZIP 92399-567
Phone: (760) 619-0663

The enumeration date for this NPI number is 8/5/2013 and was last updated on 8/5/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YM0800X	Counselor	Mental Health		CALIFORNIA	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)		CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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