=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164295424
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIRECOVERY PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2023
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 S MAIN ST STE 6
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-904-3659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 S MAIN ST STE 6
-----------------------------------------------------
City | CHELSEA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48118-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-904-3659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | STEPHEN M PHILLIPS
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 734-904-3659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------