NPIMap

Organization Active NPI

Experiential Healing Center

  • Mental Health Counselor
  • Memphis, TN
National Provider Identifier
1558084780
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
EXPERIENTIAL HEALING CENTER
Practice address
1713 Lockett PL
Memphis, TN 38104-3923
Phone
(901) 372-0710
NPI assigned
Sep 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Mrs. Ethel Youngren
Title
Office Manager
Phone
(901) 372-0710

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

1713 Lockett PL
Memphis, TN 38104-3923

Mailing address

1713 Lockett PL
Memphis, TN 38104-3923
Phone (901) 372-0710

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address office@ehcmemphis.com Direct

National Provider Directory

National Provider Directory

Locations

1713 Lockett Pl
Memphis, TN 38104
Phone (901) 372-0710

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1663804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1558084780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 LOCKETT PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043923",
            "telephone_number": "901-372-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1713 LOCKETT PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043923",
            "telephone_number": "901-372-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERIENTIAL HEALING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "YOUNGREN",
        "authorized_official_first_name": "ETHEL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "901-372-0710",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@ehcmemphis.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "office@ehcmemphis.com",
            "address_1": "1713 Lockett Pl",
            "city": "Memphis",
            "state": "TN",
            "country_code": "US",
            "postal_code": "381043923",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.