Provider Demographics
NPI:1417364621
Name:AMOS, MARVIN CHARLES (MACMHC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:CHARLES
Last Name:AMOS
Suffix:
Gender:M
Credentials:MACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 MCCARN CIR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-4176
Mailing Address - Country:US
Mailing Address - Phone:865-307-0694
Mailing Address - Fax:
Practice Address - Street 1:449 MCCARN CIR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-4176
Practice Address - Country:US
Practice Address - Phone:865-453-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health