Healthcare Provider Details

I. General information

NPI: 1114834801
Provider Name (Legal Business Name): QUALITY BEHAVIORAL FAMILY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NEW COVINGTON PIKE STE 109
MEMPHIS TN
38128-2526
US

IV. Provider business mailing address

3900 NEW COVINGTON PIKE STE 109
MEMPHIS TN
38128-2526
US

V. Phone/Fax

Practice location:
  • Phone: 901-634-7548
  • Fax:
Mailing address:
  • Phone: 901-634-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. MONEEKA FOULKS
Title or Position: OWNER
Credential: OWNER
Phone: 901-634-7548