Provider Demographics
NPI:1134903362
Name:SAMARITAN COUNSELING CENTERS OF THE MID-SOUTH
Entity type:Organization
Organization Name:SAMARITAN COUNSELING CENTERS OF THE MID-SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-212-2160
Mailing Address - Street 1:35 S AUBURNDALE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3916
Mailing Address - Country:US
Mailing Address - Phone:901-729-3900
Mailing Address - Fax:901-729-2737
Practice Address - Street 1:35 S AUBURNDALE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3916
Practice Address - Country:US
Practice Address - Phone:901-729-3900
Practice Address - Fax:901-729-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty