Provider Demographics
NPI:1427224435
Name:BUCKLEY, AMY TILSON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:TILSON
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:LOUISA
Other - Last Name:TILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 BEECHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3814
Mailing Address - Country:US
Mailing Address - Phone:501-993-5511
Mailing Address - Fax:
Practice Address - Street 1:11 CHILDREN'S WAY SLOT # 654
Practice Address - Street 2:SOUTH CAMPUS BLDG 5TH FLOOR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-4610
Practice Address - Country:US
Practice Address - Phone:501-364-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2189-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172504795Medicaid
AR172504795Medicaid