1932378635 NPI number — METRO COUNSELING CENTER

Table of content: (NPI 1932378635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932378635 NPI number — METRO COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO COUNSELING CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1932378635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1355 LYNNFIELD RD # B
Provider Second Line Business Mailing Address:
SUITE 245
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-818-5433
Provider Business Mailing Address Fax Number:
901-818-5435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 LYNNFIELD RD # B
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-818-5433
Provider Business Practice Location Address Fax Number:
901-818-5435
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SUMLIN
Authorized Official First Name:
OTIS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
901-818-5433

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4080319 . This is a "BLUE CROSS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3697111 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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