Provider Demographics
NPI:1992079149
Name:URSERY, PHYLLIS (LMSW)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:URSERY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CIS - LEARNING CENTER
Mailing Address - Street 2:1402 S. SAGINAW STREET
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503
Mailing Address - Country:US
Mailing Address - Phone:810-347-2937
Mailing Address - Fax:
Practice Address - Street 1:1402 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3705
Practice Address - Country:US
Practice Address - Phone:810-347-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062772171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator