Provider Demographics
NPI:1073964748
Name:ELLIOTT, AMANDA LEA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEA
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CEDAR RIDGE DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:NOLANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76559-4698
Mailing Address - Country:US
Mailing Address - Phone:254-291-8085
Mailing Address - Fax:
Practice Address - Street 1:1020 TRIMMIER RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-8029
Practice Address - Country:US
Practice Address - Phone:254-760-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB246043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst