Provider Demographics
NPI:1003111204
Name:SCRIPSICK, PHYLLIS J (MA, LPC, NCC, LBSW)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:J
Last Name:SCRIPSICK
Suffix:
Gender:F
Credentials:MA, LPC, NCC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7438 LACY DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5369
Mailing Address - Country:US
Mailing Address - Phone:734-788-9032
Mailing Address - Fax:
Practice Address - Street 1:33150 SCHOOLCRAFT RD STE 102
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1646
Practice Address - Country:US
Practice Address - Phone:734-788-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085554104100000X
MI6401012702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker