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General NPI Number Information
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NPI Number | 1669974317
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Entity Type | Organization
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Legal Business Name | MEMPHIS FAMILY CONNECTION CENTER , LLC
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 815 N MCLEAN BLVD
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City | MEMPHIS
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State | TN
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Zip | 38107-4608
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Country | US
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Telephone | 901-614-1902
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Fax |
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Provider Business Mailing Address
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Address Line | 815 N MCLEAN BLVD
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City | MEMPHIS
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State | TN
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Zip | 38107-4608
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Country | US
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Telephone | 901-614-1902
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JAMIE CHESSOR
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Credential |
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Telephone | 901-614-1902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 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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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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