Provider Demographics
NPI:1922507441
Name:PHILLIPS, JAMIE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44060 WOODWARD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5040
Mailing Address - Country:US
Mailing Address - Phone:248-978-2104
Mailing Address - Fax:
Practice Address - Street 1:44060 WOODWARD AVE STE 204
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5040
Practice Address - Country:US
Practice Address - Phone:248-978-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-10
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018476101Y00000X
MI6401016189101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor