Provider Demographics
NPI:1134977549
Name:MEMPHIS BEHAVIORAL & WELLNESS COLLECTIVE
Entity type:Organization
Organization Name:MEMPHIS BEHAVIORAL & WELLNESS COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JERRIKA
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-230-1458
Mailing Address - Street 1:8356 KEELI CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-1511
Mailing Address - Country:US
Mailing Address - Phone:901-230-1458
Mailing Address - Fax:
Practice Address - Street 1:8356 KEELI CV
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-1511
Practice Address - Country:US
Practice Address - Phone:901-230-1458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health