Healthcare Provider Details

I. General information

NPI: 1093933426
Provider Name (Legal Business Name): ELIZABETH ANN TERRELL M.EDM.DIV.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 LINDEN AVE
MEMPHIS TN
38126-2023
US

IV. Provider business mailing address

427 LINDEN AVE
MEMPHIS TN
38126-2023
US

V. Phone/Fax

Practice location:
  • Phone: 901-577-0200
  • Fax: 901-577-0229
Mailing address:
  • Phone: 901-577-0200
  • Fax: 901-577-0229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: