Provider Demographics
NPI:1205670908
Name:AMOH JNR, SAMUEL (RBT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:AMOH JNR
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 LYRA DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5814
Mailing Address - Country:US
Mailing Address - Phone:254-394-9164
Mailing Address - Fax:
Practice Address - Street 1:310 W CENTRAL TEXAS EXPY STE 4
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-2573
Practice Address - Country:US
Practice Address - Phone:254-833-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-352513106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician