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NPI Code Detail

MEDICARE: MR. PHILLIP JAMES ZEZULAK LPC, CAADC

MEDICARE:  MR. PHILLIP JAMES ZEZULAK  LPC, CAADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor6401019593MI
2101YM0800XMental Health Counselor6401019593MI
3101YP2500XProfessional Counselor6401019593MI

General Provider Information

NPI Number : 1740659218
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PHILLIP JAMES ZEZULAK LPC, CAADC
Provider Business Mailing Address
First Line : 1480 N M 52 STE 1
Second Line :
City : OWOSSO
State : MI
Zip : 48867-1025
Country : US
Telephone Number : 989-723-8239
Fax Number : 989-723-8230
Provider Business Practice Location Address
First Line : 1480 N M 52 STE 1
Second Line :
City : OWOSSO
State : MI
Zip : 48867-1025
Country : US
Telephone Number : 989-723-8239
Fax Number : 989-723-8230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2015
Last Update Date : 12/13/2022

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Directions to “ MR. PHILLIP JAMES ZEZULAK LPC, CAADC” Practice Location

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