Healthcare Provider Details

I. General information

NPI: 1487400024
Provider Name (Legal Business Name): COMMUNITY CONNECT BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 DRAYTON WOODS DR
MEMPHIS TN
38134-3213
US

IV. Provider business mailing address

3251 DRAYTON WOODS DR
MEMPHIS TN
38134-3213
US

V. Phone/Fax

Practice location:
  • Phone: 901-644-9244
  • Fax:
Mailing address:
  • Phone: 901-644-9244
  • Fax:

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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KHELSEA WALKER
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 901-644-9244