Organization
CUSTOMIZED MEDICAL NEEDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTI ALEXANDER DAVIDSON (EXECUTIVE DIRECTOR)
(866) 563-7772
Entity
Organization
Contact information
Practice address
578 HARRELL ST, MEMPHIS, TN 38112-2932
(901) 907-0640
(901) 255-0758
Mailing address
578 HARRELL ST, MEMPHIS, TN 38112-2932
(901) 907-0640
(901) 255-0758
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
305
TN
104100000X
Social Worker
—
—
133V00000X
Registered Dietitian
—
—
163W00000X
Registered Nurse
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103G700897
MEDICARE (PTAN)
TN
05
—
1531379
—
TN
Enumeration date
04/03/2013
Last updated
09/29/2025
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