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General NPI Number Information
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NPI Number | 1477137826
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Entity Type | Individual
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Provider Name | MS. AMY MICHELLE NULL
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Gender | Female
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 275 COUNTY HIGHWAY 84
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City | PHIL CAMPBELL
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State | AL
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Zip | 35581-6509
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Country | US
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Telephone | 256-627-4032
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Fax |
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Provider Business Mailing Address
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Address Line | 7542 SULPHUR SPRINGS RD
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City | RAMER
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State | TN
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Zip | 38367-5425
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Country | US
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Telephone | 731-610-0424
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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 | 18-60970
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License Number State | TN
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