MEDICARE: AMY LEETH BCBA

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
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1235794231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LEETH BCBA

Provider Business Mailing Address
First Line	:	860 HAINES STE 220
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1006
Country	:	US
Telephone Number	:	816-265-1170
Fax Number	:

Provider Business Practice Location Address
First Line	:	860 HAINES STE 220
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-1006
Country	:	US
Telephone Number	:	816-265-1170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2019
Last Update Date	:	10/07/2024

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