MEDICARE: ANTOINETTE SMITH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1326776840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE SMITH

Provider Business Mailing Address
First Line	:	2036 WALL ST APT 8
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-9687
Country	:	US
Telephone Number	:	615-617-0370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 MADISON AVE # 2835
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-2620
Country	:	US
Telephone Number	:	901-609-5030
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/14/2022

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Directions to “ ANTOINETTE SMITH ” Practice Location

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