Provider Demographics
NPI:1467621334
Name:CET OF MEMPHIS, LLC
Entity Type:Organization
Organization Name:CET OF MEMPHIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:THIGPEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-358-5347
Mailing Address - Street 1:2470 CAPEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127
Mailing Address - Country:US
Mailing Address - Phone:901-358-5347
Mailing Address - Fax:
Practice Address - Street 1:2470 CAPEWOOD DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127
Practice Address - Country:US
Practice Address - Phone:901-482-7633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000000333251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441469Medicaid