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General NPI Number Information
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NPI Number | 1831220920
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Entity Type | Individual
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Provider Name | PHILIP KENNETH AXTELL PHD
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 2210 SUTHERLAND AVE STE 114
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City | KNOXVILLE
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State | TN
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Zip | 37919-2337
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Country | US
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Telephone | 865-556-8947
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Fax | 865-895-4142
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Provider Business Mailing Address
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Address Line | 2210 SUTHERLAND AVE STE 114
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City | KNOXVILLE
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State | TN
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Zip | 37919-2337
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Country | US
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Telephone | 865-556-6092
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Fax | 865-895-4142
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | P2763
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 2763
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2763
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License Number State | TN
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