MEDICARE: ALLY COUNSELING AND PSYCHOLOGICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1124736749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLY COUNSELING AND PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	830 N BROADWAY ST
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-7259
Country	:	US
Telephone Number	:	618-967-2387
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 N BROADWAY ST
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37917-7259
Country	:	US
Telephone Number	:	618-967-2387
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. ANGELA NIKKI HILTON
Credential	:	PHD
Telephone Number	:	865-213-2751

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	04/01/2024

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