Provider Demographics
NPI:1275043192
Name:CAMBOU, AMY SUMMER (BCBA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUMMER
Last Name:CAMBOU
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 1:809 MCCLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9603
Mailing Address - Country:US
Mailing Address - Phone:530-227-1002
Mailing Address - Fax:
Practice Address - Street 1:809 MCCLOUD AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9603
Practice Address - Country:US
Practice Address - Phone:530-227-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst