MEDICARE: AMANDA NICOLE FULLBRIGHT MS, 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518234467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NICOLE FULLBRIGHT MS, BCBA

Provider Business Mailing Address
First Line	:	1817 HAMILTON DR
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-4515
Country	:	US
Telephone Number	:	940-399-9909
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 SAN FELIPE ST STE 990
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-1708
Country	:	US
Telephone Number	:	346-388-3754
Fax Number	:

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

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	05/17/2024

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