Provider Demographics
NPI:1689856601
Name:BELLMYER, AMANDA LEE (MED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LEE
Last Name:BELLMYER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 COLUMBIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:256-404-8657
Mailing Address - Fax:877-286-4141
Practice Address - Street 1:928 MANCHESTER EXPY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6535
Practice Address - Country:US
Practice Address - Phone:706-649-1371
Practice Address - Fax:877-286-4141
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1063046103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst