MR. Phillip Shack Utumapu, RAS

NPI #1962834721 in Yucaipa, California

Provider Information

NPI Number: 1962834721
Entity Type: Individual
Name: MR. Phillip Shack Utumapu, RAS
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Addiction (Substance Use Disorder)
Credential: RAS
Enumeration Date: Aug 5, 2013
Last Updated: Aug 5, 2013

Practice Location

Address: 13626 HOLMES ST APT 16
City: Yucaipa
State: California
ZIP Code: 92399-5567
Phone: (760) 619-0663

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X	Primary
Counselor - Mental Health — Mental Health	101YM0800X

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Kimberly Ann Swank	Counselor - Addiction (Substance Use Disorder)	Yucaipa	AI Deep Dive
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Organizations

Provider Name	Specialty	City
Hidden Hope Residential	Counselor - Addiction (Substance Use Disorder)	Yucaipa	AI Deep Dive
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