Provider Demographics
NPI:1063787646
Name:LAFEVERS, AMANDA LANETTE
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LANETTE
Last Name:LAFEVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:LANETTE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2607 CADDO ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5307
Mailing Address - Country:US
Mailing Address - Phone:870-230-8217
Mailing Address - Fax:870-230-8201
Practice Address - Street 1:2607 CADDO ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5307
Practice Address - Country:US
Practice Address - Phone:870-230-8217
Practice Address - Fax:870-230-8201
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst