Basic Information
| Provider Information | |||||||||
| NPI: | 1245702810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADEN | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | COUNSELOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5310 BALL CAMP PIKE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379213234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652628208 | ||||||||
| FaxNumber: | 8655416959 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 W SPRINGDALE AVE | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379175158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656379711 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2018 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.