Provider Demographics
NPI:1174969083
Name:COUNSELING SOLUTIONS OF THE MIDSOUTH,LLC
Entity type:Organization
Organization Name:COUNSELING SOLUTIONS OF THE MIDSOUTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRICKA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:615-389-3477
Mailing Address - Street 1:3750 HACKS CROSS RD
Mailing Address - Street 2:SUITE 102-314
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3750 HACKS CROSS RD
Practice Address - Street 2:SUITE 102-314
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2367
Practice Address - Country:US
Practice Address - Phone:615-389-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-18
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5784101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty