Provider Demographics
NPI:1952090557
Name:QUINN, PHILLIP JOSHUA (MDIV, MA, LLPC)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JOSHUA
Last Name:QUINN
Suffix:
Gender:M
Credentials:MDIV, MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8998
Mailing Address - Country:US
Mailing Address - Phone:616-222-0631
Mailing Address - Fax:
Practice Address - Street 1:388 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8998
Practice Address - Country:US
Practice Address - Phone:616-222-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health