Provider Demographics
NPI:1740825322
Name:SMITH, ALEXIS G (TLPC-MHSP, NCC)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:TLPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MIGNON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38107-5115
Mailing Address - Country:US
Mailing Address - Phone:615-969-6367
Mailing Address - Fax:
Practice Address - Street 1:2610 AUTUMN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2739
Practice Address - Country:US
Practice Address - Phone:901-451-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health