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General NPI Number Information
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NPI Number | 1427393750
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGY PROFESSIONALS
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 2519 NILES AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1936
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Country | US
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Telephone | 269-277-6657
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Fax |
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Provider Business Mailing Address
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Address Line | 2519 NILES AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-1936
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Country | US
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Telephone | 269-277-6657
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONALD K. PHILLIPS
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Credential | M.A.
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Telephone | 269-277-6657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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