Provider Demographics
NPI:1174934913
Name:HASTY, AMY R
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:HASTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MADISON 2475
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740-7412
Mailing Address - Country:US
Mailing Address - Phone:479-738-7186
Mailing Address - Fax:
Practice Address - Street 1:210 MADISON 2475
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-7412
Practice Address - Country:US
Practice Address - Phone:479-738-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool