Provider Demographics
NPI:1801151329
Name:POWELL, WENDY ANN (LPC-MHSP)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 BRAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3930
Mailing Address - Country:US
Mailing Address - Phone:901-275-1104
Mailing Address - Fax:901-751-8105
Practice Address - Street 1:2262 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3805
Practice Address - Country:US
Practice Address - Phone:090-127-5110
Practice Address - Fax:901-751-8105
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000002853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health