Healthcare Provider Details

I. General information

NPI: 1336342831
Provider Name (Legal Business Name): MIDTOWN MENTAL HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
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: 901-577-0207
Mailing address:
  • Phone: 901-577-0200
  • Fax: 901-577-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL2190176475
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL2140766276
License Number StateTN

VIII. Authorized Official

Name: MR. AUBREY J. HOWARD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 901-577-9463