Provider Demographics
NPI:1710582721
Name:PARKER, AMBER (BCBA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:PARKER
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 1:10797 ARTESIA WELLS ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8637
Mailing Address - Country:US
Mailing Address - Phone:813-407-1092
Mailing Address - Fax:
Practice Address - Street 1:5755 S RAINBOW BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2535
Practice Address - Country:US
Practice Address - Phone:813-407-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-55228103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst