Provider Demographics
NPI:1649510397
Name:PHILLIPS, PAMELA MARY (MA, LLPC, NCC, SCL)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MARY
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA, LLPC, NCC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 HIDDEN LN
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:MI
Mailing Address - Zip Code:48367-3226
Mailing Address - Country:US
Mailing Address - Phone:248-760-4377
Mailing Address - Fax:
Practice Address - Street 1:2155 HIDDEN LN
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:MI
Practice Address - Zip Code:48367-3226
Practice Address - Country:US
Practice Address - Phone:248-760-4377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012742101YP2500X
MISC0000000773950101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool