Healthcare Provider Details

I. General information

NPI: 1801708698
Provider Name (Legal Business Name): LATASHIA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 ELMHURST ST
HIGHLAND PARK MI
48203-3412
US

IV. Provider business mailing address

252 ELMHURST ST
HIGHLAND PARK MI
48203-3412
US

V. Phone/Fax

Practice location:
  • Phone: 313-585-9366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: