Provider Demographics
NPI:1205979671
Name:POWELL, AMY MARIE (MA, LPE)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 375
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6140
Mailing Address - Country:US
Mailing Address - Phone:615-327-4877
Mailing Address - Fax:615-327-4881
Practice Address - Street 1:30 BURTON HILLS BLVD
Practice Address - Street 2:SUITE 375
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-6140
Practice Address - Country:US
Practice Address - Phone:615-327-4877
Practice Address - Fax:615-327-4881
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000011686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4028199OtherBCBS OF TN