Provider Demographics
NPI:1912155854
Name:FRANCIS, PHILLIP MARTIN (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:MARTIN
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78705 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-2142
Mailing Address - Country:US
Mailing Address - Phone:586-752-4979
Mailing Address - Fax:
Practice Address - Street 1:43900 GARFIELD RD
Practice Address - Street 2:SUITE 222
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1128
Practice Address - Country:US
Practice Address - Phone:586-263-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2195045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional