Tarik Immanuel, NCC, LPC/MHSP (TEMP)

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

7963 Issued in TN

Practice address

293 S Walnut Bend Rd
Cordova, TN 38018-7284

Phone

(901) 206-5604

NPI assigned

Sep 12, 2025

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757635200000",
    "number": "1497626659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 S WALNUT BEND RD",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380187284",
            "telephone_number": "901-206-5604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "293 S WALNUT BEND RD",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380187284",
            "telephone_number": "901-206-5604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMANUEL",
        "first_name": "TARIK",
        "name_prefix": "Mr.",
        "credential": "NCC, LPC/MHSP (TEMP)",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-12",
        "last_updated": "2025-09-12",
        "certification_date": "2025-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "7963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Cordova, TN
• Providers in Cordova, TN by specialty
• Mental Health Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.