Provider Demographics
NPI:1063098531
Name:AMWAY
Entity type:Organization
Organization Name:AMWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HYWEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-216-9836
Mailing Address - Street 1:5339 ALBEMARLE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-8201
Mailing Address - Country:US
Mailing Address - Phone:901-484-3524
Mailing Address - Fax:
Practice Address - Street 1:3225 KIRBY WHITTEN RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2893
Practice Address - Country:US
Practice Address - Phone:901-216-9836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty