Provider Demographics
NPI:1346854619
Name:COOMBS, AMY DENISE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:DENISE
Last Name:COOMBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9132 N WILDERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-4740
Mailing Address - Country:US
Mailing Address - Phone:901-218-9997
Mailing Address - Fax:
Practice Address - Street 1:3771 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-6020
Practice Address - Country:US
Practice Address - Phone:901-584-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-20-133555106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician