MEDICARE: CARLTON LEIST LMSW

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	104100000X	Social Worker	14811	TN

General Provider Information

NPI Number	:	1356128649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLTON LEIST LMSW

Provider Business Mailing Address
First Line	:	6509 RIVER SPRING CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2653
Country	:	US
Telephone Number	:	901-504-8848
Fax Number	:

Provider Business Practice Location Address
First Line	:	6509 RIVER SPRING CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2653
Country	:	US
Telephone Number	:	901-504-8848
Fax Number	:

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

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	09/11/2023

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Directions to “ CARLTON LEIST LMSW” Practice Location

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