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General NPI Number Information
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NPI Number | 1144049024
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Entity Type | Organization
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Legal Business Name | CLR MIND PSYCHIATRY, LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 4466 ELVIS PRESLEY BLVD STE 119
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City | MEMPHIS
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State | TN
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Zip | 38116-7129
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Country | US
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Telephone | 901-878-9147
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Fax |
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Provider Business Mailing Address
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Address Line | 4466 ELVIS PRESLEY BLVD STE 119
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City | MEMPHIS
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State | TN
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Zip | 38116-7129
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Country | US
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Telephone | 901-878-9147
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | MARQUETA ABRAHAM
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Credential | DNP
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Telephone | 901-878-9147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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