MEDICARE: THE MENTAL AND EMOTIONAL RESOURCE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1336910413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MENTAL AND EMOTIONAL RESOURCE CENTER

Provider Business Mailing Address
First Line	:	1565 OVERTON PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-5136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1565 OVERTON PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-5136
Country	:	US
Telephone Number	:	901-729-7825
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NANCY LIEBBE
Credential	:
Telephone Number	:	901-729-7825

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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