Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 103G00000X | Clinical Psychologist | 6301016014 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301016014 | MI |
NPI | 1023238623 |
---|---|
Provider Name | Dr. Phyllis M. Florian |
First Address | Kalamazoo, MI 49006-2015 |
Second Address | Kalamazoo, MI 49006-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 27/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6301012839 | MICHIGAN STATE DEPT. OF LICENSING AND REGULATORY AFFAIRS (01) | MI |
6301016014 | DOCTORAL LICENSE IN PSYCHOLOGY (01) | MI |