Provider Demographics
NPI:1902103542
Name:PHILLIPS, JULIE ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HOSTETLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:414 S MAIN ST STE 208B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2070
Mailing Address - Country:US
Mailing Address - Phone:586-256-5820
Mailing Address - Fax:855-493-9978
Practice Address - Street 1:414 S MAIN ST STE 208B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2070
Practice Address - Country:US
Practice Address - Phone:586-256-5820
Practice Address - Fax:855-493-9978
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010832421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical