Provider Demographics
NPI:1205911393
Name:CHANIN, PHILIP (EDD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:CHANIN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 21ST AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4908
Mailing Address - Country:US
Mailing Address - Phone:615-386-3333
Mailing Address - Fax:615-386-3353
Practice Address - Street 1:2313 21ST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-4908
Practice Address - Country:US
Practice Address - Phone:615-386-3333
Practice Address - Fax:615-386-3353
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001568103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3685147Medicaid
TN0135186OtherBLUE CROSS BLUE SHIELD
TN0135186OtherBLUE CROSS BLUE SHIELD