Provider Demographics
NPI:1962834994
Name:PHILLIPS, STACY LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 MURFREESBORO RD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1306
Mailing Address - Country:US
Mailing Address - Phone:615-790-0567
Mailing Address - Fax:615-595-8030
Practice Address - Street 1:1113 MURFREESBORO RD
Practice Address - Street 2:SUITE 319
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-1306
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:615-595-8030
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health