Provider Demographics
NPI:1134138100
Name:MOSBY, PHILLIP SHERIDAN (LMSW ACSW)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:SHERIDAN
Last Name:MOSBY
Suffix:
Gender:M
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-6833
Mailing Address - Country:US
Mailing Address - Phone:989-596-3558
Mailing Address - Fax:989-401-7509
Practice Address - Street 1:4318 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1267
Practice Address - Country:US
Practice Address - Phone:810-249-9924
Practice Address - Fax:810-249-9927
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6801018735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801018735OtherSTATE OF MI DEPT OF COMM