Provider Demographics
NPI:1316437437
Name:KIRK, AMBER YOUNG (BCBA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:YOUNG
Last Name:KIRK
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 1:25813 FOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9652
Mailing Address - Country:US
Mailing Address - Phone:863-205-1242
Mailing Address - Fax:
Practice Address - Street 1:25813 FOUNTAIN TRL
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9652
Practice Address - Country:US
Practice Address - Phone:863-205-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician