Healthcare Provider Details

I. General information

NPI: 1952911455
Provider Name (Legal Business Name): MS. BRIANNA AMABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 ALUMNI AVE
MEMPHIS TN
38152-0001
US

IV. Provider business mailing address

5014 WILL FALL RD
BARTLETT TN
38002-8921
US

V. Phone/Fax

Practice location:
  • Phone: 901-678-2068
  • Fax:
Mailing address:
  • Phone: 901-574-2996
  • 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: