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General NPI Number Information
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NPI Number | 1497481956
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Entity Type | Individual
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Provider Name | PHILIP KRYSINSKI JR. MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 15600 19 MILE RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-3502
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Country | US
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Telephone | 586-330-0708
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 ORCHARD LAKE RD STE 180-151
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-1604
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Country | US
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Telephone | 586-330-0702
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6451022131
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401224668
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License Number State | MI
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