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General NPI Number Information
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NPI Number | 1922896877
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Entity Type | Individual
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Provider Name | SAMUEL RAINES
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Gender | Male
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Dates
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Enumeration Date | 04/29/2025
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 2000 N PARKWAY
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City | MEMPHIS
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State | TN
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Zip | 38112-1624
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Country | US
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Telephone | 901-843-3128
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 WILL SCARLET RD
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City | MEMPHIS
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State | TN
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Zip | 38111-6576
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Country | US
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Telephone | 731-499-4030
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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 | 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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