Provider Demographics
NPI:1225668379
Name:HERNDON, PHILLIP ANTHONY (LPC, MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:HERNDON
Suffix:
Gender:M
Credentials:LPC, MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8964 BIG OAK DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-7906
Mailing Address - Country:US
Mailing Address - Phone:615-499-5453
Mailing Address - Fax:
Practice Address - Street 1:1819 WARD DR STE 102
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-0567
Practice Address - Country:US
Practice Address - Phone:615-499-5453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional