Healthcare Provider Details

I. General information

NPI: 1013736768
Provider Name (Legal Business Name): ALIVE MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 W POPLAR AVE STE 110
COLLIERVILLE TN
38017-0618
US

IV. Provider business mailing address

7556 US HIGHWAY 70 STE 105
BARTLETT TN
38133-2686
US

V. Phone/Fax

Practice location:
  • Phone: 901-568-7774
  • Fax:
Mailing address:
  • Phone: 901-568-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARA WILLIAMS LABRADOR
Title or Position: MANAGER
Credential:
Phone: 901-568-7774