1861512014 NPI number — TERRI LYNNE KNOWLTON-RICHARDS CMSW

Table of content: TERRI LYNNE KNOWLTON-RICHARDS CMSW (NPI 1861512014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861512014 NPI number — TERRI LYNNE KNOWLTON-RICHARDS CMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNOWLTON-RICHARDS
Provider First Name:
TERRI
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861512014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6874 MAGNOLIA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLIVE BRANCH
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38654-4380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-893-1117
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 LINDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38126-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-577-9400
Provider Business Practice Location Address Fax Number:
901-577-0200
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  CSW0000003376 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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