Healthcare Provider Details

I. General information

NPI: 1770221335
Provider Name (Legal Business Name): MAUREEN JANICE MCPHAIL LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 8TH ST
PORT HURON MI
48060-5804
US

IV. Provider business mailing address

1406 8TH ST
PORT HURON MI
48060-5804
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-1258
  • Fax: 810-987-3505
Mailing address:
  • Phone: 810-987-1258
  • Fax: 810-987-3505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26152070608
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: