Healthcare Provider Details

I. General information

NPI: 1073491221
Provider Name (Legal Business Name): MY LEGACY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR STE 150
MEMPHIS TN
38125-8900
US

IV. Provider business mailing address

4844 BLOOMFIELD DR
MEMPHIS TN
38125-3356
US

V. Phone/Fax

Practice location:
  • Phone: 901-468-3431
  • Fax: 877-353-0135
Mailing address:
  • Phone: 901-468-3431
  • Fax: 877-353-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLI HOLLOWAY
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 901-468-3431