Provider Demographics
NPI:1174845614
Name:NOFFSINGER, PHILLIP T (LPCC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:T
Last Name:NOFFSINGER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 DESTINY LN STE 107
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1088
Mailing Address - Country:US
Mailing Address - Phone:615-419-6878
Mailing Address - Fax:
Practice Address - Street 1:1830 DESTINY LN STE 107
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1088
Practice Address - Country:US
Practice Address - Phone:615-419-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid
KY7100325720Medicaid