Individual
MR. TARIK IMMANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NCC, LPC/MHSP (TEMP)
Contact information
Practice address
293 S WALNUT BEND RD, CORDOVA, TN 38018-7284
(901) 206-5604
Mailing address
293 S WALNUT BEND RD, CORDOVA, TN 38018-7284
(901) 206-5604
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7963
TN
Other
Enumeration date
09/12/2025
Last updated
09/12/2025
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