Provider Demographics
NPI:1427670306
Name:TRICKEL, AMANDA KAY (BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:TRICKEL
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S DOUGLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:844-856-9711
Mailing Address - Fax:305-846-9711
Practice Address - Street 1:1716 CORPORATE XING
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3734
Practice Address - Country:US
Practice Address - Phone:618-206-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-24-76136103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILB255-0119-7818OtherDRIVERS LICENSE
BACB575303OtherBACB