# THE WELLNESS SPACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194695452
- **Authorized official:** CHANTE SMITH-FASON DNP (CEO)
- **Authorized official phone:** (901) 450-3995

## Contact information

- **Practice address:** 1331 UNION AVE STE 1152, MEMPHIS, TN 38104-7509
- **Practice address phone:** (901) 450-3995
- **Practice address fax:** (901) 450-3995
- **Mailing address:** 5821 PARK AVE \# 171432, MEMPHIS, TN 38119-5134
- **Mailing address phone:** (901) 450-3995
- **Mailing address fax:** (901) 450-3995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/10/2025
- **Last updated:** 11/10/2025