Healthcare Provider Details

I. General information

NPI: 1063066652
Provider Name (Legal Business Name): AMANDA CARTER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CASEY ST STE A
CAMPBELLSVILLE KY
42718-6858
US

IV. Provider business mailing address

121 CASEY ST STE A
CAMPBELLSVILLE KY
42718-6858
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-7768
  • Fax: 270-465-0068
Mailing address:
  • Phone: 270-465-7768
  • Fax: 270-465-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number245463
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: