Provider Demographics
NPI:1912486879
Name:GOFORTH, AMBER LYNN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:GOFORTH
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14723 W OAKS PLAZA DR APT 1221
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-3991
Mailing Address - Country:US
Mailing Address - Phone:337-212-5966
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1803 RICHMOND PKWY STE 600
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3641
Practice Address - Country:US
Practice Address - Phone:346-241-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA103K00000X
TX3238103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst