Provider Demographics
NPI:1558035055
Name:PANTHER CREEK FOUNDATION
Entity Type:Organization
Organization Name:PANTHER CREEK FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MYLISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORROCKS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:901-574-1740
Mailing Address - Street 1:2531 SHILLINGFORD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-7820
Mailing Address - Country:US
Mailing Address - Phone:901-574-1740
Mailing Address - Fax:
Practice Address - Street 1:5750 CONGER RD
Practice Address - Street 2:
Practice Address - City:NESBIT
Practice Address - State:MS
Practice Address - Zip Code:38651-8898
Practice Address - Country:US
Practice Address - Phone:662-912-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty