Provider Demographics
NPI:1427778141
Name:DAVIS, AMANDA CLAIRE (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:CLAIRE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CLAIRE
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1309 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4546
Mailing Address - Country:US
Mailing Address - Phone:972-786-5997
Mailing Address - Fax:
Practice Address - Street 1:1309 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4546
Practice Address - Country:US
Practice Address - Phone:972-786-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5284103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst