Provider Demographics
NPI:1336421452
Name:EAST TENNESSEE PSYCHOLOGICAL TESTING
Entity type:Organization
Organization Name:EAST TENNESSEE PSYCHOLOGICAL TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:K
Authorized Official - Last Name:AXTELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-247-4055
Mailing Address - Street 1:8905 SONY LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5218
Mailing Address - Country:US
Mailing Address - Phone:865-247-4055
Mailing Address - Fax:844-388-6159
Practice Address - Street 1:8905 SONY LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5218
Practice Address - Country:US
Practice Address - Phone:865-247-4055
Practice Address - Fax:844-388-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2763103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty