Provider Demographics
NPI:1083973960
Name:PHILLIPS, CHRISTOPHER PAUL
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:PHILLIPS
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 1:1110 WOODBURY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2758
Mailing Address - Country:US
Mailing Address - Phone:931-205-6828
Mailing Address - Fax:931-685-9337
Practice Address - Street 1:1110 WOODBURY ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2758
Practice Address - Country:US
Practice Address - Phone:931-205-6828
Practice Address - Fax:931-685-9337
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker