Individual
KEITH FREDERIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
TLPC-MHSP
Contact information
Practice address
5587 MURRAY AVE STE 205, MEMPHIS, TN 38119-0896
(901) 501-7119
Mailing address
6952 PARKBROOK LN, CORDOVA, TN 38018-7936
(901) 501-7119
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6792
TN
Other
Enumeration date
01/27/2025
Last updated
01/27/2025
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