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General NPI Number Information
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NPI Number | 1528635851
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Entity Type | Organization
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Legal Business Name | TELEWELLNESS THERAPY, LLC
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 2408 SCEPTER LN
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City | HOOVER
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State | AL
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Zip | 35226-2902
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Country | US
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Telephone | 205-370-5156
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 SCEPTER LN
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City | HOOVER
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State | AL
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Zip | 35226-2902
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Country | US
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Telephone | 205-370-5156
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/FOUNDER
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Name | AMANDA MYERS CAMPOS
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Credential | PSYD
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Telephone | 205-370-5156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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