Provider Demographics
NPI:1295163053
Name:IRVIN, AMBER (BCBA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:IRVIN
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 1:6229 WHIMBRELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4103
Mailing Address - Country:US
Mailing Address - Phone:828-450-7932
Mailing Address - Fax:
Practice Address - Street 1:6229 WHIMBRELWOOD DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-4103
Practice Address - Country:US
Practice Address - Phone:828-450-7932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst