Basic Information
| Provider Information | |||||||||
| NPI: | 1134138100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSBY | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | SHERIDAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1013 N RIVER RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486096833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895963558 | ||||||||
| FaxNumber: | 9894017509 | ||||||||
| Practice Location | |||||||||
| Address1: | 4318 MILLER RD | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485071267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102499924 | ||||||||
| FaxNumber: | 8102499927 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801018735 | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 6801018735 | 01 | MI | STATE OF MI DEPT OF COMM | OTHER |