Provider Demographics
NPI:1164288072
Name:AMOS, ARIYANA ASHUNTI
Entity Type:Individual
Prefix:
First Name:ARIYANA
Middle Name:ASHUNTI
Last Name:AMOS
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 1:105 DOLEAC DR APT 211
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3118
Mailing Address - Country:US
Mailing Address - Phone:601-668-3146
Mailing Address - Fax:
Practice Address - Street 1:4229 U S HIGHWAY 11
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8024
Practice Address - Country:US
Practice Address - Phone:601-447-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRBT-23-314223106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician