Provider Demographics
NPI:1043749534
Name:PHILLIPS, STEPHEN (LMSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 JEFFORDS STE 303
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-0029
Mailing Address - Country:US
Mailing Address - Phone:734-904-3659
Mailing Address - Fax:
Practice Address - Street 1:4925 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1521
Practice Address - Country:US
Practice Address - Phone:734-971-9781
Practice Address - Fax:734-971-2730
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801100913104100000X
MI6801108897104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker