MEDICARE: LENN HARRIS MILAM, 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
1	251S00000X	Community/Behavioral Health Agency	0646	TN

General Provider Information

NPI Number	:	1841565736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENN HARRIS MILAM, LLC

Provider Business Mailing Address
First Line	:	1565 OVERTON PARK AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-5136
Country	:	US
Telephone Number	:	901-387-9943
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	:	901-387-9943
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LENN HARRIS MILAM
Credential	:	LMFT, LCPT
Telephone Number	:	901-387-9943

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	03/12/2012

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