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NPI Code Detail

MEDICARE: AMANDA BURLEY MED, BCBA, LBA

MEDICARE: AMANDA BURLEY MED, BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst2016021207MO

General Provider Information

NPI Number : 1063865665
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA BURLEY MED, BCBA, LBA
Provider Business Mailing Address
First Line : 94 HOLLISTER CT
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-7837
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 94 HOLLISTER CT
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-7837
Country : US
Telephone Number : 314-305-0041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2016
Last Update Date : 08/28/2019

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