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NPI Code Detail

MEDICARE: MRS. AMANDA LYN COUCH M.A., BCBA

MEDICARE: MRS. AMANDA LYN COUCH M.A., 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
1103K00000XBehavior Analyst1-20-44619OK

General Provider Information

NPI Number : 1669080297
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMANDA LYN COUCH M.A., BCBA
Provider Business Mailing Address
First Line : 2603 W BATON ROUGE PL
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74011-2022
Country : US
Telephone Number : 208-221-4599
Fax Number :
Provider Business Practice Location Address
First Line : 2208 W DETROIT ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-3629
Country : US
Telephone Number : 918-900-6237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2020
Last Update Date : 10/26/2022

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