Provider Demographics
NPI:1437893385
Name:COLLIE, AMY LE (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LE
Last Name:COLLIE
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4515 POPLAR AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-7506
Mailing Address - Country:US
Mailing Address - Phone:901-654-5551
Mailing Address - Fax:
Practice Address - Street 1:4515 POPLAR AVE STE 224
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-7506
Practice Address - Country:US
Practice Address - Phone:901-654-5551
Practice Address - Fax:901-654-5570
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health