Healthcare Provider Details

I. General information

NPI: 1427670306
Provider Name (Legal Business Name): AMANDA KAY TRICKEL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 CORPORATE XING
O FALLON IL
62269-3734
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 618-206-8816
  • Fax:
Mailing address:
  • Phone: 844-856-9711
  • Fax: 305-846-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76136
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: