Healthcare Provider Details

I. General information

NPI: 1578068821
Provider Name (Legal Business Name): AMBER LYNN STABENAU MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 S ALMONT AVE
IMLAY CITY MI
48444-9732
US

IV. Provider business mailing address

2538 LISA DR
COLUMBIAVILLE MI
48421-8910
US

V. Phone/Fax

Practice location:
  • Phone: 810-510-0026
  • Fax:
Mailing address:
  • Phone: 810-358-4808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133002326
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001221
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2022000275
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: