Provider Demographics
NPI:1164057279
Name:MIDSOUTH THERAPY GROUP
Entity Type:Organization
Organization Name:MIDSOUTH THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYNER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:901-830-1363
Mailing Address - Street 1:1236 CHERRYDALE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-8104
Mailing Address - Country:US
Mailing Address - Phone:479-461-7738
Mailing Address - Fax:
Practice Address - Street 1:1236 CHERRYDALE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-8104
Practice Address - Country:US
Practice Address - Phone:479-461-7738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty