Provider Demographics
NPI:1104443605
Name:EVANS, AMANDA LEIGH (BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:EVANS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TEPEE TRL
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2034
Mailing Address - Country:US
Mailing Address - Phone:856-470-7411
Mailing Address - Fax:
Practice Address - Street 1:116 TEPEE TRL
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2034
Practice Address - Country:US
Practice Address - Phone:856-470-7411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-42951103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst