Provider Demographics
NPI:1295898393
Name:ALLIANCE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:ALLIANCE HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-567-3554
Mailing Address - Street 1:2220 UNION AVE
Mailing Address - Street 2:ALLIANCE HEALTHCARE SERVICES
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-369-1420
Mailing Address - Fax:901-369-1433
Practice Address - Street 1:2150 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6662
Practice Address - Country:US
Practice Address - Phone:901-353-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL2140766281251B00000X, 251S00000X
TNL2140766280251B00000X, 251S00000X
TNL2140766279251B00000X, 251S00000X
TN269251S00000X
TNL2140766278251S00000X
TN251S00000X, 261QP2300X
261QM0801X, 261QP2300X
TNL18537261QP2300X
TN276251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3399596Medicaid
TN399596Medicaid
TN3399596Medicaid