Provider Demographics
NPI:1831841030
Name:PHILLIPSPLANT, MICAH MARTHA (MHC)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:MARTHA
Last Name:PHILLIPSPLANT
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 34TH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1188
Mailing Address - Country:US
Mailing Address - Phone:918-574-4728
Mailing Address - Fax:
Practice Address - Street 1:140 BROADWAY # 4657
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-1108
Practice Address - Country:US
Practice Address - Phone:201-351-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health