MEDICARE: TONI LOUIS MS, LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	3919	TN
2	101YM0800X	Mental Health Counselor	3919	TN
3	101YP2500X	Professional Counselor	3919	TN

General Provider Information

NPI Number	:	1912425703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI LOUIS MS, LPC

Provider Business Mailing Address
First Line	:	335 OAKRIDGE DR
Second Line	:
City	:	OAKLAND
State	:	TN
Zip	:	38060-3287
Country	:	US
Telephone Number	:	901-340-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	8566 CORDES CIR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38139-3317
Country	:	US
Telephone Number	:	901-340-3500
Fax Number	:

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

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	08/31/2017

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