Healthcare Provider Details

I. General information

NPI: 1619843661
Provider Name (Legal Business Name): DR. AMANDA ESTELLE MCLARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N COLLEGE AVE
FAYETTEVILLE AR
72703-1999
US

IV. Provider business mailing address

7540 WYANDOTTE ST
KANSAS CITY MO
64114-1819
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-4301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number03415
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: