Provider Demographics
NPI:1659834687
Name:GIBBONS, AMYEE (MS BCBA LBA)
Entity Type:Individual
Prefix:
First Name:AMYEE
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MS BCBA LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6435 W HIGHWAY 146
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-8502
Mailing Address - Country:US
Mailing Address - Phone:502-709-5240
Mailing Address - Fax:855-632-0826
Practice Address - Street 1:6435 W HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-8502
Practice Address - Country:US
Practice Address - Phone:502-709-5240
Practice Address - Fax:855-632-0826
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBACB451953103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275171662OtherTRICARE
RBT-18-65004OtherRBT CERTIFICATE