Provider Demographics
NPI:1497981708
Name:LEVITT, PHYLLIS ELLEN (MA LLP)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ELLEN
Last Name:LEVITT
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4592 FAIRWAY RDG
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3309
Mailing Address - Country:US
Mailing Address - Phone:248-855-8442
Mailing Address - Fax:
Practice Address - Street 1:4592 FAIRWAY RDG
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3309
Practice Address - Country:US
Practice Address - Phone:248-855-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007857103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral