Provider Demographics
NPI:1386653723
Name:ADAMS, AMY MICHELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MICHELLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PARADISE PL
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9312
Mailing Address - Country:US
Mailing Address - Phone:479-616-2280
Mailing Address - Fax:479-442-1779
Practice Address - Street 1:821 PARADISE PL
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9312
Practice Address - Country:US
Practice Address - Phone:479-616-2280
Practice Address - Fax:479-442-1779
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0310040101YP2500X
ARM0411003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y437OtherBCBS NUMBER