MEDICARE: LITTLE GLOW COUNSELING PLLC

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1417807439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE GLOW COUNSELING PLLC

Provider Business Mailing Address
First Line	:	5747 NANJACK CIR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2058
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5747 NANJACK CIR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-2058
Country	:	US
Telephone Number	:	901-401-1003
Fax Number	:

Authorized Official
Title or Position	:	LMFT
Name	:	WING SUM TAM
Credential	:
Telephone Number	:	901-570-3591

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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