MEDICARE: JUANITA WILCHIE LPC,MHSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC0000001615	TN

General Provider Information

NPI Number	:	1215093992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA WILCHIE LPC,MHSP

Provider Business Mailing Address
First Line	:	3000 SHADOW GREEN LN
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-7460
Country	:	US
Telephone Number	:	901-574-2850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 KIRBY PKWY
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-4367
Country	:	US
Telephone Number	:	901-574-2850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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