Provider Demographics
NPI:1457057499
Name:WORD, AMBER RAE (BT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RAE
Last Name:WORD
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:RAE
Other - Last Name:IRELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-8211
Mailing Address - Country:US
Mailing Address - Phone:931-201-6090
Mailing Address - Fax:
Practice Address - Street 1:2965 FORT CAMPBELL BLVD STE 600
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-0405
Practice Address - Country:US
Practice Address - Phone:931-271-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician