Healthcare Provider Details

I. General information

NPI: 1093634198
Provider Name (Legal Business Name): JANE TERRELL MIMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 CENTERVIEW PKWY STE 511
CORDOVA TN
38018-4254
US

IV. Provider business mailing address

8000 CENTERVIEW PKWY STE 511
CORDOVA TN
38018-4254
US

V. Phone/Fax

Practice location:
  • Phone: 901-417-7434
  • Fax:
Mailing address:
  • Phone: 901-417-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8789
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: