Healthcare Provider Details

I. General information

NPI: 1265004931
Provider Name (Legal Business Name): JAX BEHAVIORAL HEALTH, LLPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5158 STAGE RD STE 110
MEMPHIS TN
38134-3116
US

IV. Provider business mailing address

6830 GARMIN LN
CORDOVA TN
38018-8850
US

V. Phone/Fax

Practice location:
  • Phone: 901-277-3318
  • Fax: 901-592-4606
Mailing address:
  • Phone: 901-277-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JAMESA YVETTE ALSTON
Title or Position: OWNER/BCBA
Credential: MS, BCBA,LBA
Phone: 901-277-3318