Healthcare Provider Details

I. General information

NPI: 1801151329
Provider Name (Legal Business Name): WENDY ANN POWELL LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 S GERMANTOWN RD
GERMANTOWN TN
38138-3805
US

IV. Provider business mailing address

1303 BRAYSHORE DR
COLLIERVILLE TN
38017-3930
US

V. Phone/Fax

Practice location:
  • Phone: 90-127-5110
  • Fax: 901-751-8105
Mailing address:
  • Phone: 901-275-1104
  • Fax: 901-751-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000002853
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: