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6401 Poplar Ave Ste 500 Memphis TN 38119-4808 | |
| (901) 746-9438 | |
| (941) 746-9331 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 6401 Poplar Ave Ste 500, Memphis, Tennessee |
| Authorized Official Name and Position | Marina Jo Mahoney (VP OF RCM AND PAYOR RELATIONS) |
| Authorized Official Contact | 9515602877 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3312 Teasley Ln Ste 100 Denton TX 76210-8311 Ph: (940) 360-4245 | 6401 Poplar Ave Ste 500 Memphis TN 38119-4808 Ph: (901) 746-9438 |
| NPI Number | 1487126272 |
|---|---|
| Provider Enumeration Date | 12/18/2018 |
| Last Update Date | 06/10/2024 |
| Certification Date | 06/10/2024 |
| Medicare PECOS PAC ID | 5496181133 |
|---|---|
| Medicare Enrollment ID | O20200128003261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487126272 | NPI | - | NPPES |
| Q048108 | Medicaid | TN | |
| 03401509 | Medicaid | MS |
| Provider Name | Shawn Hamm |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1821330895 PECOS PAC ID: 2264651397 Enrollment ID: I20171024003089 |
| Provider Name | Allen K Gholston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548380991 PECOS PAC ID: 4981963394 Enrollment ID: I20180110002195 |
| Provider Name | James B Mckenzie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386952299 PECOS PAC ID: 2365745148 Enrollment ID: I20210802003238 |
| Provider Name | Adam Nanaa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225767130 PECOS PAC ID: 3678939634 Enrollment ID: I20230517000451 |
| Provider Name | Rachel A Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043637101 PECOS PAC ID: 4385074202 Enrollment ID: I20240807004272 |
| Provider Name | Sarita Subedi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962271015 PECOS PAC ID: 9931647138 Enrollment ID: I20240820000387 |
| Provider Name | Lauren Ashley Mcclairen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457886129 PECOS PAC ID: 6709318868 Enrollment ID: I20241014002793 |
| Provider Name | Brandance G Dyar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427611250 PECOS PAC ID: 4688108046 Enrollment ID: I20241108000262 |
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