Healthcare Provider Details

I. General information

NPI: 1619889185
Provider Name (Legal Business Name): KAREN THRELKELD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GERMANTOWN CT STE 200
CORDOVA TN
38018-4268
US

IV. Provider business mailing address

57 GERMANTOWN CT STE 200
CORDOVA TN
38018-4268
US

V. Phone/Fax

Practice location:
  • Phone: 901-316-7963
  • Fax:
Mailing address:
  • Phone: 901-316-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8291
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: