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General NPI Number Information
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NPI Number | 1205709615
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Entity Type | Individual
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Provider Name | AMANDA MICHELLE GALVAN TREJO
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Gender | Female
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 5250 E US HIGHWAY 36 STE 360
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City | AVON
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State | IN
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Zip | 46123-9151
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Country | US
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Telephone | 463-297-7792
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Fax |
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Provider Business Mailing Address
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Address Line | 8846 MEDORA DR APT 1D
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City | CAMBY
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State | IN
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Zip | 46113-8399
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Country | US
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Telephone | 463-297-7792
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-25-474259
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License Number State | IN
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