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NPI Code Detail

MEDICARE: THALIA PSYCHIATRY AND COUNSELING LLC

MEDICARE: THALIA PSYCHIATRY AND COUNSELING LLC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1700685377
Entity Type Code : Organization
Provider Name (Legal Business Name) : THALIA PSYCHIATRY AND COUNSELING LLC
Provider Business Mailing Address
First Line : 5865 RIDGEWAY CENTER PKWY STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-4014
Country : US
Telephone Number : 901-648-3380
Fax Number :
Provider Business Practice Location Address
First Line : 5865 RIDGEWAY CENTER PKWY STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-4014
Country : US
Telephone Number : 901-648-3380
Fax Number :
Authorized Official
Title or Position : OWNER
Name : AMANDA F TENISON
Credential :
Telephone Number : 901-648-3380
Provider Enumeration Date : 03/07/2025
Last Update Date : 03/19/2026

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