Healthcare Provider Details

I. General information

NPI: 1972844827
Provider Name (Legal Business Name): AMY BOEGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 MEMORIAL CIR
CLARKSVILLE TN
37043-4539
US

IV. Provider business mailing address

4747 GUTHRIE HWY
CLARKSVILLE TN
37040-5423
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7300
  • Fax:
Mailing address:
  • Phone: 254-458-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: