Keith Frederic, TLPC-MHSP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6792 Issued in TN

Practice address

5587 Murray Ave Ste 205
Memphis, TN 38119-0896

Phone

(901) 501-7119

NPI assigned

Jan 27, 2025

Last updated

Jan 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1737936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1730992645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6952 PARKBROOK LN",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380187936",
            "telephone_number": "901-501-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5587 MURRAY AVE STE 205",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381190896",
            "telephone_number": "901-501-7119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERIC",
        "first_name": "KEITH",
        "credential": "TLPC-MHSP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-01-27",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TN",
            "license": "6792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Memphis, TN
• Providers in Memphis, 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 Jan 27, 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.