Provider Demographics
NPI:1912069352
Name:BOAZ, ANTHONY DUANE
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DUANE
Last Name:BOAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 N GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-3501
Mailing Address - Country:US
Mailing Address - Phone:501-664-2898
Mailing Address - Fax:
Practice Address - Street 1:2205 N GARFIELD ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-3501
Practice Address - Country:US
Practice Address - Phone:501-664-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1808-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical