Provider Demographics
NPI:1720797061
Name:PHILLIPS, LEZAH (LPC)
Entity Type:Individual
Prefix:
First Name:LEZAH
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31118 COUNTRY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5963
Mailing Address - Country:US
Mailing Address - Phone:313-268-7175
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD STE D
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5474
Practice Address - Country:US
Practice Address - Phone:810-597-9331
Practice Address - Fax:810-534-5222
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional