THE HEADSHOP NPI 1508643818

NPI Information

  • NPI: 1508643818
  • Provider Name: THE HEADSHOP
  • Classification: Counselor - 101YP2500X
  • Specialization: Professional
  • Entity Type: Organization
  • :
  • Address: 5104 STAGE RD
    MEMPHIS, TN
    ZIP 38134
  • Phone: (901) 870-8682

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NPI Details

THE HEADSHOP is a professional counselor in Memphis, TN. THE HEADSHOP NPI is 1508643818. The provider is registered as an organization entity type and is a single specialty group.
The provider .

The provider's business location address is:

5104 STAGE RD
MEMPHIS, TN
ZIP 38134-164
Phone: (901) 870-8682
Fax: (901) 424-9078

The provider's authorized official is Mardrey Alicia Wade Kiles .
The authorized official title is Owner, Clinical Director, Therapist and has the following contact phone number (901) 870-8682.

The enumeration date for this NPI number is 9/11/2023 and was last updated on 10/27/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1101YP2500XCounselorProfessionalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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