Provider Demographics
NPI:1164679957
Name:BLANSETT, PHILLIP L (LPC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:L
Last Name:BLANSETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 EAGLE TRACE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7428
Mailing Address - Country:US
Mailing Address - Phone:615-758-3810
Mailing Address - Fax:253-322-4905
Practice Address - Street 1:1621 EAGLE TRACE DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-7428
Practice Address - Country:US
Practice Address - Phone:615-758-3810
Practice Address - Fax:253-322-4905
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3128544OtherBLUE CROSS AND BLUE SHIELD OF TENNESSEE