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General NPI Number Information
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NPI Number | 1417423906
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Entity Type | Individual
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Provider Name | ROCHELLE REYLE LPC-MHSP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 661 MADISON AVE
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City | MEMPHIS
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State | TN
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Zip | 38103-3307
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Country | US
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Telephone | 901-267-4015
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Fax |
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Provider Business Mailing Address
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Address Line | 2014 DOGWOOD GROVE CV
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City | GERMANTOWN
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State | TN
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Zip | 38139-5647
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Country | US
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Telephone | 858-220-6145
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC0000004329
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License Number State | TN
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