Provider Demographics
NPI:1942828462
Name:COMAGE-TROWER, AMANDA CARLETHA (RBT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CARLETHA
Last Name:COMAGE-TROWER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:LAVALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3215 W RAY RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2425
Mailing Address - Country:US
Mailing Address - Phone:623-707-7209
Mailing Address - Fax:
Practice Address - Street 1:3215 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2425
Practice Address - Country:US
Practice Address - Phone:623-707-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-19-5058-152124106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician