Provider Demographics
NPI:1043532716
Name:GEARHARD, AMY K (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:GEARHARD
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 MAJESTIC DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8510
Mailing Address - Country:US
Mailing Address - Phone:303-935-5200
Mailing Address - Fax:
Practice Address - Street 1:1724 MAJESTIC DR
Practice Address - Street 2:SUITE 109
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8510
Practice Address - Country:US
Practice Address - Phone:303-935-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst