Healthcare Provider Details

I. General information

NPI: 1457661621
Provider Name (Legal Business Name): BETTY A WINTER ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S AUBURNDALE ST
MEMPHIS TN
38104-3916
US

IV. Provider business mailing address

186 CRESTMERE PL
MEMPHIS TN
38112-3202
US

V. Phone/Fax

Practice location:
  • Phone: 901-729-3900
  • Fax: 901-729-2737
Mailing address:
  • Phone: 901-219-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0000000579
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: