Provider Demographics
NPI:1033355870
Name:CRISP, AMANDA MARIE (LPC, CCTP)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:CRISP
Suffix:
Gender:F
Credentials:LPC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N. WALTON BLVD.
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:479-271-6203
Mailing Address - Fax:479-271-6247
Practice Address - Street 1:115 JEFFERSON ST SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3945
Practice Address - Country:US
Practice Address - Phone:870-836-8888
Practice Address - Fax:870-836-8881
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1112098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARNONEOtherMENTAL HEALTH PROFESSIONAL-COUNSELOR