Provider Demographics
NPI:1578636544
Name:SPROUSE, PHILIP EDWARD (MSW)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:EDWARD
Last Name:SPROUSE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:EDDIE
Other - Middle Name:
Other - Last Name:SPROUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1385 MISSION ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2623
Mailing Address - Country:US
Mailing Address - Phone:415-864-7833
Mailing Address - Fax:415-864-7093
Practice Address - Street 1:1385 MISSION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2623
Practice Address - Country:US
Practice Address - Phone:415-864-7833
Practice Address - Fax:415-864-7093
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health