Healthcare Provider Details

I. General information

NPI: 1083299929
Provider Name (Legal Business Name): ELIZABETH R DRAIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 POPLAR AVE STE 1118
MEMPHIS TN
38157-1118
US

IV. Provider business mailing address

PO BOX 746725
ATLANTA GA
30374-6725
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-5658
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000004672
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: