Provider Demographics
NPI:1801648530
Name:FELHOFER, AMANDA (LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FELHOFER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 ROPE TRL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-6211
Mailing Address - Country:US
Mailing Address - Phone:936-676-1552
Mailing Address - Fax:
Practice Address - Street 1:628 W BROADWAY ST STE 300
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-5547
Practice Address - Country:US
Practice Address - Phone:501-301-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2312010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health