Provider Demographics
NPI:1972324564
Name:TOWNSEND, PHILLIP JAMES-SCOTT
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JAMES-SCOTT
Last Name:TOWNSEND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 COOLEY DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-1232
Mailing Address - Country:US
Mailing Address - Phone:248-796-2726
Mailing Address - Fax:
Practice Address - Street 1:809 CENTER ST STE 7B
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5257
Practice Address - Country:US
Practice Address - Phone:517-485-7581
Practice Address - Fax:517-485-7581
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker