Provider Demographics
NPI:1306419049
Name:PHILLIP EMERSON SERVICES, LLC
Entity Type:Organization
Organization Name:PHILLIP EMERSON SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LISW
Authorized Official - Phone:216-315-3570
Mailing Address - Street 1:14701 DETROIT AVE STE 775
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4120
Mailing Address - Country:US
Mailing Address - Phone:216-315-3570
Mailing Address - Fax:216-228-1610
Practice Address - Street 1:14701 DETROIT AVE STE 775
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4120
Practice Address - Country:US
Practice Address - Phone:216-315-3570
Practice Address - Fax:216-228-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty