Provider Demographics
NPI:1356335376
Name:PHILP, ALLAN SWAYZE (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:SWAYZE
Last Name:PHILP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 PARK WEST BLVD
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4404
Mailing Address - Country:US
Mailing Address - Phone:865-690-8702
Mailing Address - Fax:865-690-3697
Practice Address - Street 1:9217 PARK WEST BLVD
Practice Address - Street 2:SUITE D-2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4404
Practice Address - Country:US
Practice Address - Phone:865-690-8702
Practice Address - Fax:865-690-3697
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1252103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3582940Medicaid
TN3582940Medicaid