Provider Demographics
NPI:1730784828
Name:MANGAT, PHILLIP ALAN (MS, LBS)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALAN
Last Name:MANGAT
Suffix:
Gender:M
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 SATURN DR
Mailing Address - Street 2:
Mailing Address - City:EFFORT
Mailing Address - State:PA
Mailing Address - Zip Code:18330-9749
Mailing Address - Country:US
Mailing Address - Phone:272-207-8113
Mailing Address - Fax:
Practice Address - Street 1:217 SATURN DR
Practice Address - Street 2:
Practice Address - City:EFFORT
Practice Address - State:PA
Practice Address - Zip Code:18330-9749
Practice Address - Country:US
Practice Address - Phone:272-207-8113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH005679103K00000X, 103K00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty