Provider Demographics
NPI:1922572536
Name:CRIST, AMBER SUZANNE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:SUZANNE
Last Name:CRIST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:4721 S. CLIFF. AVE.
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055
Mailing Address - Country:US
Mailing Address - Phone:816-608-1500
Mailing Address - Fax:
Practice Address - Street 1:4721 S. CLIFF. AVE.
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-608-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSRBT-15-08410106S00000X
MOBCBA1-20-45035103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician