Provider Demographics
NPI:1932378635
Name:METRO COUNSELING CENTER
Entity Type:Organization
Organization Name:METRO COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:901-818-5433
Mailing Address - Street 1:1355 LYNNFIELD RD # B
Mailing Address - Street 2:SUITE 245
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5801
Mailing Address - Country:US
Mailing Address - Phone:901-818-5433
Mailing Address - Fax:901-818-5435
Practice Address - Street 1:1355 LYNNFIELD RD # B
Practice Address - Street 2:SUITE 245
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5801
Practice Address - Country:US
Practice Address - Phone:901-818-5433
Practice Address - Fax:901-818-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4080319OtherBLUE CROSS OF TN
TN3697111Medicaid
TN3697111Medicaid