Individual
PHILIP RICHARD GRANISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLP
Contact information
Practice address
4341 S. WESTNEDGE, SUITE 1103, KALAMAZOO, MI 49008
(269) 982-3832
(269) 281-0351
Mailing address
4384 LAUREL DRIVE, SAINT JOSEPH, MI 49085
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361006461
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43191
MICHIGAN DEPARTMENT OF CORRECTIONS PROVIDER ID NUMBER
MI
Enumeration date
02/02/2017
Last updated
02/23/2023
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