Provider Demographics
NPI:1245733401
Name:SKINNER, AMY L
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC-MHSP, ACS
Mailing Address - Street 1:5448 LANCE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1851
Mailing Address - Country:US
Mailing Address - Phone:865-258-8297
Mailing Address - Fax:
Practice Address - Street 1:10426 JACKSON OAKS WAY STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-0709
Practice Address - Country:US
Practice Address - Phone:052-588-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty