Provider Demographics
NPI:1003516469
Name:ENGELSMA, AMBER LEIGH
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:ENGELSMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2550
Mailing Address - Country:US
Mailing Address - Phone:850-781-0406
Mailing Address - Fax:850-378-5233
Practice Address - Street 1:225 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2550
Practice Address - Country:US
Practice Address - Phone:850-781-0406
Practice Address - Fax:850-378-5233
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-261803106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician