Provider Demographics
NPI:1689136699
Name:VANN, AMY ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:VANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 WATER ST
Mailing Address - Street 2:
Mailing Address - City:SPEEDWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37870-7879
Mailing Address - Country:US
Mailing Address - Phone:423-489-0319
Mailing Address - Fax:
Practice Address - Street 1:110 WHEELER LN STE 6
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2901
Practice Address - Country:US
Practice Address - Phone:423-201-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016637101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health