Provider Demographics
NPI:1891816468
Name:ELZINGA, PHILIP MORRIE (MA, LLP PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MORRIE
Last Name:ELZINGA
Suffix:
Gender:M
Credentials:MA, LLP PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CENTURY LANE
Mailing Address - Street 2:PATHWAYS, MI
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423
Mailing Address - Country:US
Mailing Address - Phone:616-396-2301
Mailing Address - Fax:616-396-8070
Practice Address - Street 1:121 CLOVER ST.
Practice Address - Street 2:MICHIGAN WORKS
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-494-3498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012957103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling