Provider Demographics
NPI:1376984146
Name:LESSOR, AMBER N (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:LESSOR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 NE SHADY LANE DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5027
Mailing Address - Country:US
Mailing Address - Phone:816-590-2316
Mailing Address - Fax:
Practice Address - Street 1:2203 NE SHADY LANE DR
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-5027
Practice Address - Country:US
Practice Address - Phone:816-853-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1376870865OtherSUMMIT BEHAVIORAL SERVICES