Healthcare Provider Details

I. General information

NPI: 1104960319
Provider Name (Legal Business Name): AMANDA BROWNDERVILLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 BATESVILLE BLVD STE C
BATESVILLE AR
72501-8972
US

IV. Provider business mailing address

70 BATESVILLE BLVD STE C
BATESVILLE AR
72501-8972
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-3199
  • Fax: 870-793-3151
Mailing address:
  • Phone: 870-793-3199
  • Fax: 870-793-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA0310087
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: