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General NPI Number Information
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NPI Number | 1619042561
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Entity Type | Organization
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Legal Business Name | SAMARITAN COUNSELING CENTER OF THE MIDSOUTH
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 35 S AUBURNDALE ST
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City | MEMPHIS
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State | TN
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Zip | 38104-3916
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Country | US
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Telephone | 901-729-3900
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Fax | 901-729-2737
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Provider Business Mailing Address
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Address Line | 35 S AUBURNDALE ST
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City | MEMPHIS
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State | TN
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Zip | 38104-3916
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Country | US
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Telephone | 901-729-3900
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Fax | 901-729-2737
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Authorized Official
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Title or Position | DIRECTOR
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Name | KRISTIN FOX-TRAUTMAN
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Credential |
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Telephone | 901-729-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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