MEDICARE: MRS. MATTIE BOYD HUGHLETT LCSW

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	1041C0700X	Clinical Social Worker	LSW 0000003298	TN

General Provider Information

NPI Number	:	1609961556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MATTIE BOYD HUGHLETT LCSW

Provider Business Mailing Address
First Line	:	4443 GARRISON AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-3512
Country	:	US
Telephone Number	:	901-372-9442
Fax Number	:	901-383-2501

Provider Business Practice Location Address
First Line	:	1420 UNION AVE
Second Line	:	SUITE 230
City	:	MEMPHIS
State	:	TN
Zip	:	38104-3695
Country	:	US
Telephone Number	:	901-276-0220
Fax Number	:	901-383-2509

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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