Provider Demographics
NPI:1750898987
Name:PHILIP, LEAH ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ELIZABETH
Last Name:PHILIP
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 WOLF RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8313
Mailing Address - Country:US
Mailing Address - Phone:501-944-9110
Mailing Address - Fax:
Practice Address - Street 1:7563 NESHOBA RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2114
Practice Address - Country:US
Practice Address - Phone:615-398-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-17-28186103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst