1063853430 NPI number — MRS. AMBER MARIE REINER MS, BCBA

Table of content: MRS. AMBER MARIE REINER MS, BCBA (NPI 1063853430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063853430 NPI number — MRS. AMBER MARIE REINER MS, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINER
Provider First Name:
AMBER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILES
Provider Other First Name:
AMBER
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063853430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 CENTAUR CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80026-1432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-837-2348
Provider Business Mailing Address Fax Number:
303-559-5657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 W SOUTH BOULDER RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80026-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-837-2348
Provider Business Practice Location Address Fax Number:
303-559-5657
Provider Enumeration Date:
07/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-13-13932 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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