1508388018 NPI number — PHILLIP JAMARR FLIPPEN LMHP-R

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508388018 NPI number — PHILLIP JAMARR FLIPPEN LMHP-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLIPPEN
Provider First Name:
PHILLIP
Provider Middle Name:
JAMARR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHP-R
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508388018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
278 MAYA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RINGGOLD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24586-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-630-8494
Provider Business Mailing Address Fax Number:
888-767-7937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
278 MAYA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RINGGOLD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24586-2904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-630-8494
Provider Business Practice Location Address Fax Number:
888-767-7937
Provider Enumeration Date:
07/17/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 27-4726213 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1225570195 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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