Provider Demographics
NPI:1255671376
Name:KORPUSIK, PHILIP FRANK (LMSW)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:FRANK
Last Name:KORPUSIK
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 1:27609 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1766
Mailing Address - Country:US
Mailing Address - Phone:586-779-8666
Mailing Address - Fax:
Practice Address - Street 1:2122 15 MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4853
Practice Address - Country:US
Practice Address - Phone:586-264-3692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801059407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health