Provider Demographics
NPI:1124483102
Name:BLAIR, AMANDA (EDS, LPC, NCSP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:EDS, LPC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N PEAR ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5273
Mailing Address - Country:US
Mailing Address - Phone:501-380-7333
Mailing Address - Fax:501-380-7010
Practice Address - Street 1:202 N PEAR ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5273
Practice Address - Country:US
Practice Address - Phone:501-380-7333
Practice Address - Fax:501-380-7010
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1602016101YP2500X, 101Y00000X
AR10051133103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool