Provider Demographics
NPI:1558628289
Name:MYERS, AMBER RENEA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RENEA
Last Name:MYERS
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:PO BOX 91895
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70609-0001
Mailing Address - Country:US
Mailing Address - Phone:337-562-4115
Mailing Address - Fax:
Practice Address - Street 1:107 MALLARD ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-6515
Practice Address - Country:US
Practice Address - Phone:337-304-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-11-9579103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst