Healthcare Provider Details

I. General information

NPI: 1467643783
Provider Name (Legal Business Name): AMANDA G OWENS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N HAZEN AVE
HAZEN AR
72064
US

IV. Provider business mailing address

650 S SHACKLEFORD RD SUITE 217
LITTLE ROCK AR
72211-3522
US

V. Phone/Fax

Practice location:
  • Phone: 870-255-3527
  • Fax: 870-255-3528
Mailing address:
  • Phone: 501-221-1843
  • Fax: 501-221-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1868-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: