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NPI Code Detail

MEDICARE: AMANDA LYNN COVILLE MA, BCBA, LBA

MEDICARE: AMANDA LYNN COVILLE MA, 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 Analyst

General Provider Information

NPI Number : 1831684935
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LYNN COVILLE MA, BCBA, LBA
Provider Business Mailing Address
First Line : 15481 S 27TH ST
Second Line :
City : VICKSBURG
State : MI
Zip : 49097-9371
Country : US
Telephone Number : 269-290-2803
Fax Number :
Provider Business Practice Location Address
First Line : 3744 GULL RD
Second Line :
City : KALAMAZOO
State : MI
Zip : 49048-7642
Country : US
Telephone Number : 269-459-7821
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2018
Last Update Date : 03/29/2023

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