Provider Demographics
NPI:1831409051
Name:RALSTON, AMANDA J (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:RALSTON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-0216
Mailing Address - Country:US
Mailing Address - Phone:859-421-4915
Mailing Address - Fax:859-899-9202
Practice Address - Street 1:1035 STRADER DR STE 150
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4090
Practice Address - Country:US
Practice Address - Phone:859-899-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
KYKY-2000103K00000X
KYKABALBLBA00211224103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst