Individual provider Active NPI

Elizabeth Mitchell Streete, PHD

  • Psychologist
  • Memphis, TN
National Provider Identifier
1952351363
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
P1609 Issued in TN
Practice address
1282 Union Ave
Healthsouth Rehabilitation Hospital
Memphis, TN 38104-3414
Phone
(901) 729-5168
NPI assigned
May 10, 2006
Last updated
Jun 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X P1609 TN Primary

Addresses

Primary practice location

1282 Union Ave
Healthsouth Rehabilitation Hospital
Memphis, TN 38104-3414

Mailing address

1743 Carruthers PL
Memphis, TN 38112-5301
Phone (901) 729-5168

Other identifiers 3

IdentifierTypeStateIssuer
3094738OtherTNBCBS OF TN
3689381MedicaidTN
00120517MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111130000906 TN Practitioner - Clinical Psychologist 8729251137 Practice locations: Memphis, TN

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1282 Union Ave
Memphis, TN 38104-3414
Phone (901) 722-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
P1609TNMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1952351363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1743 CARRUTHERS PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381125301",
            "telephone_number": "901-729-5168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1282 UNION AVE",
            "address_2": "HEALTHSOUTH REHABILITATION HOSPITAL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043414",
            "telephone_number": "901-729-5168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STREETE",
        "first_name": "ELIZABETH",
        "middle_name": "MITCHELL",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P1609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TN",
            "identifier": "3094738",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3689381",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00120517",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.