Healthcare Provider Details

I. General information

NPI: 1245012368
Provider Name (Legal Business Name): ALISA ANN HORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 POPLAR AVE STE 302
MEMPHIS TN
38117-4433
US

IV. Provider business mailing address

1829 N PARKWAY
MEMPHIS TN
38112-5021
US

V. Phone/Fax

Practice location:
  • Phone: 901-930-7397
  • Fax:
Mailing address:
  • Phone: 901-569-6526
  • 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: