Provider Demographics
NPI:1255836466
Name:HALLOCK, AMANDA GRACE (MA, LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:GRACE
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:MA, LPC-MHSP (TEMP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 OVERLOOK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2710
Mailing Address - Country:US
Mailing Address - Phone:615-538-7317
Mailing Address - Fax:
Practice Address - Street 1:9025 OVERLOOK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2710
Practice Address - Country:US
Practice Address - Phone:615-538-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health