Healthcare Provider Details

I. General information

NPI: 1023972825
Provider Name (Legal Business Name): MAHDEE RASUL MS, LADAC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 MURRAY AVE STE 204
MEMPHIS TN
38119-3898
US

IV. Provider business mailing address

118 PEYTON RUN LOOP E
COLLIERVILLE TN
38017-1258
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-6210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: