Basic Information
| Provider Information | |||||||||
| NPI: | 1306926514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENDALL | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | LSPE/HSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2723 MCVAY RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381198514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014842034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1997 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380193630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014768967 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 08/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PE0000011561 | TN | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.