Provider Demographics
NPI:1952351363
Name:STREETE, ELIZABETH MITCHELL (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MITCHELL
Last Name:STREETE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 CARRUTHERS PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5301
Mailing Address - Country:US
Mailing Address - Phone:901-729-5168
Mailing Address - Fax:
Practice Address - Street 1:1282 UNION AVE
Practice Address - Street 2:HEALTHSOUTH REHABILITATION HOSPITAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3414
Practice Address - Country:US
Practice Address - Phone:901-729-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1609103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120517Medicaid
TN3689381Medicaid
TN3094738OtherBCBS OF TN
TN3689381Medicare PIN
MS00120517Medicaid
TN3689381Medicaid