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General NPI Number Information
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NPI Number | 1831328210
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Entity Type | Organization
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Legal Business Name | PORT HURON BEHAVIORAL SPECIALISTS
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 309 MCMORRAN BLVD
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City | PORT HURON
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State | MI
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Zip | 48060-3807
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Country | US
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Telephone | 810-488-7974
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Fax | 810-794-7751
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Provider Business Mailing Address
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Address Line | 309 MCMORRAN BLVD
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City | PORT HURON
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State | MI
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Zip | 48060-3807
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Country | US
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Telephone | 810-488-7974
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Fax | 810-794-8851
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | PHILLIPA LOUISE ZYLANOFF
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Credential | M.D.
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Telephone | 810-633-9211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 430105549
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License Number State | MI
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