Provider Demographics
NPI:1538486618
Name:TIERCE, AMANDA (QBHP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TIERCE
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 E HIGHLAND DR STE B
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6491
Mailing Address - Country:US
Mailing Address - Phone:870-520-5014
Mailing Address - Fax:
Practice Address - Street 1:2711 W KINGSHIGHWAY STE 14
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2645
Practice Address - Country:US
Practice Address - Phone:870-215-0673
Practice Address - Fax:870-215-0683
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1538486618Medicaid
AR181698795Medicaid