Healthcare Provider Details

I. General information

NPI: 1457936114
Provider Name (Legal Business Name): SWEETGRASS COUNSELING & CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2899 S MENDENHALL RD STE 1
MEMPHIS TN
38115-2247
US

IV. Provider business mailing address

10640 BIRD STONE CV
CORDOVA TN
38016-5561
US

V. Phone/Fax

Practice location:
  • Phone: 901-245-3220
  • Fax: 901-370-3265
Mailing address:
  • Phone: 901-500-5899
  • Fax: 901-370-3265

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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANEIKA SMITH
Title or Position: CO-OWNER
Credential: LPC-MHSP
Phone: 901-500-6899