Provider Demographics
NPI:1275038713
Name:AMIRAH, JAMILAH (BCBA)
Entity Type:Individual
Prefix:
First Name:JAMILAH
Middle Name:
Last Name:AMIRAH
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 1:2025 N 3RD ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1472
Mailing Address - Country:US
Mailing Address - Phone:602-283-1573
Mailing Address - Fax:
Practice Address - Street 1:11024 N 28TH DR STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029
Practice Address - Country:US
Practice Address - Phone:602-944-6222
Practice Address - Fax:602-944-3534
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AZ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst