Healthcare Provider Details

I. General information

NPI: 1831220920
Provider Name (Legal Business Name): PHILIP KENNETH AXTELL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 SUTHERLAND AVE STE 114
KNOXVILLE TN
37919-2337
US

IV. Provider business mailing address

2210 SUTHERLAND AVE STE 114
KNOXVILLE TN
37919-2337
US

V. Phone/Fax

Practice location:
  • Phone: 865-556-8947
  • Fax: 865-895-4142
Mailing address:
  • Phone: 865-556-6092
  • Fax: 865-895-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberP2763
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2763
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2763
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: