Healthcare Provider Details

I. General information

NPI: 1346116308
Provider Name (Legal Business Name): THE WELLNESS SPACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 UNION AVE STE 1152
MEMPHIS TN
38104-7509
US

IV. Provider business mailing address

5821 PARK AVE # 171432
MEMPHIS TN
38119-5134
US

V. Phone/Fax

Practice location:
  • Phone: 901-450-3995
  • Fax: 901-450-3995
Mailing address:
  • Phone: 901-450-3995
  • Fax: 901-450-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHANTE SMITH-FASON
Title or Position: CEO
Credential: DNP, FNP/PMHNP-BC
Phone: 901-450-3995