Provider Demographics
NPI:1982459079
Name:PHILLIPS, KELLY E
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTERVIEW DR UNIT 119
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5494
Mailing Address - Country:US
Mailing Address - Phone:865-686-2277
Mailing Address - Fax:
Practice Address - Street 1:300 CENTERVIEW DR UNIT 119
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5494
Practice Address - Country:US
Practice Address - Phone:865-686-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health