Provider Demographics
NPI:1477955508
Name:PHILLIPS, BRIAN (PMHNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SWEETHEART LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-9228
Mailing Address - Country:US
Mailing Address - Phone:734-474-1113
Mailing Address - Fax:
Practice Address - Street 1:2500 PACKARD ST STE 104A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6827
Practice Address - Country:US
Practice Address - Phone:734-707-1052
Practice Address - Fax:734-661-1887
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288196163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse