Provider Demographics
NPI:1962092197
Name:POOLE, AMANDA MICHELLE (MA, LBA BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:POOLE
Suffix:
Gender:F
Credentials:MA, LBA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3926 BARRON ST STE 110
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5797
Mailing Address - Country:US
Mailing Address - Phone:504-517-4282
Mailing Address - Fax:888-965-4931
Practice Address - Street 1:3926 BARRON ST STE 110
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5797
Practice Address - Country:US
Practice Address - Phone:504-517-4282
Practice Address - Fax:888-965-4931
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-500103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst