Provider Demographics
NPI:1639507577
Name:PHILLIPS-BAKER, SALENA
Entity Type:Individual
Prefix:
First Name:SALENA
Middle Name:
Last Name:PHILLIPS-BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6995 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-9506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6995 W 48TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-9506
Practice Address - Country:US
Practice Address - Phone:231-335-1718
Practice Address - Fax:231-422-0022
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012362101Y00000X
MI6301014753103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling