Provider Demographics
NPI:1629846977
Name:AMERSON, LYNDSIE RAE (BCBA)
Entity Type:Individual
Prefix:
First Name:LYNDSIE
Middle Name:RAE
Last Name:AMERSON
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 713
Mailing Address - Street 2:
Mailing Address - City:VERIBEST
Mailing Address - State:TX
Mailing Address - Zip Code:76886-0713
Mailing Address - Country:US
Mailing Address - Phone:423-920-4435
Mailing Address - Fax:
Practice Address - Street 1:425 COUNTY ROAD 198
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:TX
Practice Address - Zip Code:79562-2915
Practice Address - Country:US
Practice Address - Phone:423-920-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-23-68305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst