Active NPI
Philip Ray Nicholas, LPC-MHSP
- Mental Health Counselor
- Jackson, TN
National Provider Identifier
1568069524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5027
- Practice address
- 19 Wood Duck CV
Jackson, TN 38305-6632 - Phone
- (731) 571-7500
- NPI assigned
- Oct 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 5027 | TN | Primary |
Addresses
Primary practice location
19 Wood Duck CV
Jackson, TN 38305-6632
Mailing address
19 Wood Duck CV
Jackson, TN 38305-6632
Phone (731) 571-7500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5027 | TN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601596800000",
"number": "1568069524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19 WOOD DUCK CV",
"city": "JACKSON",
"state": "TN",
"postal_code": "383056632",
"telephone_number": "731-571-7500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19 WOOD DUCK CV",
"city": "JACKSON",
"state": "TN",
"postal_code": "383056632",
"telephone_number": "731-571-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLAS",
"first_name": "PHILIP",
"middle_name": "RAY",
"credential": "LPC-MHSP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-10-02",
"last_updated": "2020-10-02",
"certification_date": "2020-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "TN",
"license": "5027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.