Healthcare Provider Details

I. General information

NPI: 1801529763
Provider Name (Legal Business Name): AMANDA PAOLA JOVE VIVES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6312 HIGHWAY 41A STE 102
PLEASANT VIEW TN
37146-8221
US

IV. Provider business mailing address

6312 HIGHWAY 41A STE 102
PLEASANT VIEW TN
37146-8221
US

V. Phone/Fax

Practice location:
  • Phone: 615-819-5431
  • Fax: 931-245-2820
Mailing address:
  • Phone: 615-819-5431
  • Fax: 931-245-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6073
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: