Basic Information
| Provider Information | |||||||||
| NPI: | 1639260748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSSW LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARRISON | ||||||||
| OtherFirstName: | LAURIE | ||||||||
| OtherMiddleName: | POWELL | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSSW LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3810 WINCHESTER RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381189007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012599125 | ||||||||
| FaxNumber: | 9013691433 | ||||||||
| Practice Location | |||||||||
| Address1: | 3810 WINCHESTER RD | ||||||||
| Address2: | SOUTHEAST MENTAL HEALTH CENTER | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381189007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013691420 | ||||||||
| FaxNumber: | 9013691433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 4104 | TN | X | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.