Healthcare Provider Details

I. General information

NPI: 1770053191
Provider Name (Legal Business Name): AMY PROCTER MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 WATT AVE STE 120
SACRAMENTO CA
95864-5027
US

IV. Provider business mailing address

4350 AUBURN BLVD
SACRAMENTO CA
95841-4107
US

V. Phone/Fax

Practice location:
  • Phone: 916-448-2050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-73203
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-71011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: