Healthcare Provider Details

I. General information

NPI: 1508334301
Provider Name (Legal Business Name): AMANDA FAVIA BCBA 1-25-85446
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10781 E CHERRY BEND RD
TRAVERSE CITY MI
49684-5249
US

IV. Provider business mailing address

3358 RENNIE ST
TRAVERSE CITY MI
49684-4634
US

V. Phone/Fax

Practice location:
  • Phone: 231-268-0007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-85446
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: