Provider Demographics
NPI:1578123147
Name:WELLS, AMANDA (LPC-MHSP (TEMP))
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials: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 1:210 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2650
Mailing Address - Country:US
Mailing Address - Phone:615-656-0232
Mailing Address - Fax:
Practice Address - Street 1:2525 LEBANON PIKE # 202
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2414
Practice Address - Country:US
Practice Address - Phone:615-601-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6662101YM0800X
106S00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program