Provider Demographics
NPI:1326239138
Name:BARNETT, AMANDA SHIPPS (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SHIPPS
Last Name:BARNETT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SHIPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 S 9TH ST
Mailing Address - Street 2:APT. C
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2615
Mailing Address - Country:US
Mailing Address - Phone:218-341-8037
Mailing Address - Fax:
Practice Address - Street 1:3500 1ST ST S
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-4327
Practice Address - Country:US
Practice Address - Phone:719-336-7501
Practice Address - Fax:719-336-7453
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-20689103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst