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NPI Code Detail

MEDICARE: MRS. AMANDA LOIS SELF LCSW

MEDICARE: MRS. AMANDA LOIS SELF LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker115983IA
21041C0700XClinical Social Worker2615-CAR
31041C0700XClinical Social Worker20447OK

General Provider Information

NPI Number : 1982957742
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA LOIS SELF LCSW
Provider Business Mailing Address
First Line : PO BOX 15968
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72231-5968
Country : US
Telephone Number : 501-221-1843
Fax Number :
Provider Business Practice Location Address
First Line : 4354 STOCKTON DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72117-2917
Country : US
Telephone Number : 501-221-1843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2012
Last Update Date : 03/19/2026

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