| Innovative Counseling & Consulting | |
|
1455 Poplar Ave Memphis TN 38104-2934 | |
| (901) 276-0220 | |
| (901) 276-0225 |
| Full Name | Innovative Counseling & Consulting |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 1455 Poplar Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Norman N Miller (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9012760220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Counseling & Consulting 1455 Poplar Ave Memphis TN 38104-2934 Ph: (901) 276-0220 | Innovative Counseling & Consulting 1455 Poplar Ave Memphis TN 38104-2934 Ph: (901) 276-0220 |
| NPI Number | 1891820841 |
|---|---|
| Provider Enumeration Date | 02/22/2007 |
| Last Update Date | 03/30/2011 |
| Medicare PECOS PAC ID | 5890866982 |
|---|---|
| Medicare Enrollment ID | O20080617000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891820841 | NPI | - | NPPES |
| Provider Name | Yolanda Conners |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568901791 PECOS PAC ID: 6608110325 Enrollment ID: I20181207000115 |
| Provider Name | John C Cannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568584514 PECOS PAC ID: 4183012057 Enrollment ID: I20211026001018 |
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