Provider Demographics
NPI:1811350937
Name:LESSARD, AMANDA LYNNE (MA BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNNE
Last Name:LESSARD
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WADE AVE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5568
Mailing Address - Country:US
Mailing Address - Phone:404-580-0694
Mailing Address - Fax:
Practice Address - Street 1:1106 WADE AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5568
Practice Address - Country:US
Practice Address - Phone:404-580-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11621831103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst