Provider Demographics
NPI:1013193994
Name:LITTLE, AMANDA LEA (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEA
Last Name:LITTLE
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEA
Other - Last Name:TYRRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6507 JESTER BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8357
Mailing Address - Country:US
Mailing Address - Phone:785-760-4948
Mailing Address - Fax:855-726-5478
Practice Address - Street 1:6507 JESTER BLVD STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8357
Practice Address - Country:US
Practice Address - Phone:785-760-4948
Practice Address - Fax:855-726-5478
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1130OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION