MEDICARE: K. JANEE' LPC-MHSP, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1437613189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K. JANEE' LPC-MHSP, LLC

Provider Business Mailing Address
First Line	:	5909 SHELBY OAKS DR STE 117
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7318
Country	:	US
Telephone Number	:	901-361-2330
Fax Number	:

Provider Business Practice Location Address
First Line	:	5909 SHELBY OAKS DR STE 117
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7318
Country	:	US
Telephone Number	:	901-361-2330
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST/OWNER
Name	:	KRISTIN JANEE' WINBUSH
Credential	:	LPC-MHSP
Telephone Number	:	901-361-2330

Provider Enumeration Date	:	01/28/2019
Last Update Date	:	01/28/2019

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