Provider Demographics
NPI:1023238623
Name:FLORIAN, PHYLLIS M (PSYD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:M
Last Name:FLORIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 CHEROKEE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2015
Mailing Address - Country:US
Mailing Address - Phone:269-352-7922
Mailing Address - Fax:
Practice Address - Street 1:1409 CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2015
Practice Address - Country:US
Practice Address - Phone:269-352-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
MI6301016014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301016014OtherDOCTORAL LICENSE IN PSYCHOLOGY
MI6301012839OtherMICHIGAN STATE DEPT. OF LICENSING AND REGULATORY AFFAIRS