MEDICARE: AMY FOWLER LPC-MHSP(TEMP)

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	103TC1900X	Counseling Psychologist	4813	TN

General Provider Information

NPI Number	:	1245862036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY FOWLER LPC-MHSP(TEMP)

Provider Business Mailing Address
First Line	:	5037 N HILSON DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-5747
Country	:	US
Telephone Number	:	865-363-1285
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 HILLSBORO PIKE STE 300
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3344
Country	:	US
Telephone Number	:	931-486-4268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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