Provider Demographics
NPI:1518504117
Name:PHILLIPS, SHELBY HENSON (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:HENSON
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 S PETWAY ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-3321
Mailing Address - Country:US
Mailing Address - Phone:731-608-2687
Mailing Address - Fax:
Practice Address - Street 1:412 S PETWAY ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3321
Practice Address - Country:US
Practice Address - Phone:731-608-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional