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General NPI Number Information
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NPI Number | 1427224435
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Entity Type | Individual
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Provider Name | AMY TILSON BUCKLEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 11 CHILDREN'S WAY SLOT # 654 SOUTH CAMPUS BLDG 5TH FLOOR
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City | LITTLE ROCK
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State | AR
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Zip | 72202-4610
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Country | US
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Telephone | 501-364-1993
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Fax |
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Provider Business Mailing Address
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Address Line | 218 BEECHWOOD ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3814
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Country | US
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Telephone | 501-993-5511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2189-M
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License Number State | AR
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