Provider Demographics
NPI:1508374067
Name:O'MARA, AMANDA MICHELLE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:O'MARA
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FOXFIELD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4107
Mailing Address - Country:US
Mailing Address - Phone:636-706-8732
Mailing Address - Fax:636-249-1443
Practice Address - Street 1:8 FOXFIELD CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4107
Practice Address - Country:US
Practice Address - Phone:636-706-8732
Practice Address - Fax:636-249-1443
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017041229103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-27089OtherBACB
MO2017041229OtherLBA