Provider Demographics
NPI:1962714030
Name:ERNEST, PHILIP HENRY (MAC)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:HENRY
Last Name:ERNEST
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2461
Mailing Address - Country:US
Mailing Address - Phone:253-752-1860
Mailing Address - Fax:253-752-1890
Practice Address - Street 1:5002 116TH ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-5009
Practice Address - Country:US
Practice Address - Phone:253-241-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60161091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health