Provider Demographics
NPI:1306926514
Name:BENDALL, PHILLIP LEE (LSPE/HSP)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LEE
Last Name:BENDALL
Suffix:
Gender:M
Credentials:LSPE/HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-3630
Mailing Address - Country:US
Mailing Address - Phone:901-476-8967
Mailing Address - Fax:
Practice Address - Street 1:1997 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3630
Practice Address - Country:US
Practice Address - Phone:901-476-8967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000011561103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist