Active NPI
Amanda Sanders, LAC
- Mental Health Counselor
- Fayetteville, AR
National Provider Identifier
1831767359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- A2105020
- Practice address
- 2403 Main Dr
Fayetteville, AR 72704-5223 - Phone
- (479) 967-2322
- Fax
- (479) 967-2876
- NPI assigned
- Jun 11, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | A2105020 | AR | Primary |
Addresses
Primary practice location
2403 Main Dr
Fayetteville, AR 72704-5223
Mailing address
PO Box 2109
Russellville, AR 72811-2109
Phone (479) 967-2322
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A2105020 | AR | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623369600000",
"number": "1831767359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2109",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728112109",
"telephone_number": "479-967-2322",
"fax_number": "479-967-2876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2403 MAIN DR",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727045223",
"telephone_number": "479-967-2322",
"fax_number": "479-967-2876"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERS",
"first_name": "AMANDA",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-11",
"last_updated": "2021-06-11",
"certification_date": "2021-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "AR",
"license": "A2105020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.