Healthcare Provider Details

I. General information

NPI: 1891247789
Provider Name (Legal Business Name): AMBER CROSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAIN STREET
AMITY AR
71921
US

IV. Provider business mailing address

960 NORTH 8TH
ARKADELPHIA AR
71923
US

V. Phone/Fax

Practice location:
  • Phone: 870-925-0587
  • Fax:
Mailing address:
  • Phone: 870-925-0587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1402015
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMBER NICOLE TAYLOR
Title or Position: OWNER/LPC
Credential: LPC
Phone: 870-925-0587