Provider Demographics
NPI:1215093992
Name:WILCHIE, JUANITA (LPC,MHSP)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:WILCHIE
Suffix:
Gender:F
Credentials:LPC,MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SHADOW GREEN LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-7460
Mailing Address - Country:US
Mailing Address - Phone:901-574-2850
Mailing Address - Fax:
Practice Address - Street 1:1719 KIRBY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4367
Practice Address - Country:US
Practice Address - Phone:901-574-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4070444Medicare UPIN