Individual
PHILIP RAY NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC-MHSP
Contact information
Practice address
19 WOOD DUCK CV, JACKSON, TN 38305-6632
(731) 571-7500
Mailing address
19 WOOD DUCK CV, JACKSON, TN 38305-6632
(731) 571-7500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5027
TN
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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