Provider Demographics
NPI:1306855036
Name:ANTHONY, AMELIA (PHD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:901 S RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1637
Mailing Address - Country:US
Mailing Address - Phone:479-254-1144
Mailing Address - Fax:
Practice Address - Street 1:901 S RAINBOW RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1637
Practice Address - Country:US
Practice Address - Phone:479-254-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202169103TC0700X
TX24288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical