Provider Demographics
NPI:1144049024
Name:CLR MIND PSYCHIATRY, LLC
Entity type:Organization
Organization Name:CLR MIND PSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARQUETA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:901-878-9147
Mailing Address - Street 1:4466 ELVIS PRESLEY BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7129
Mailing Address - Country:US
Mailing Address - Phone:901-878-9147
Mailing Address - Fax:
Practice Address - Street 1:4466 ELVIS PRESLEY BLVD STE 119
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7129
Practice Address - Country:US
Practice Address - Phone:901-878-9147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty