Healthcare Provider Details

I. General information

NPI: 1700685377
Provider Name (Legal Business Name): THALIA PSYCHIATRY AND COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

IV. Provider business mailing address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

V. Phone/Fax

Practice location:
  • Phone: 901-648-3380
  • Fax:
Mailing address:
  • Phone: 901-648-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA F TENISON
Title or Position: OWNER
Credential:
Phone: 901-648-3380