Provider Demographics
NPI:1043860521
Name:MILLER, AMANDA (RBT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:TIBERIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9541 IRONTON WAY UNIT D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7151
Mailing Address - Country:US
Mailing Address - Phone:702-910-8607
Mailing Address - Fax:
Practice Address - Street 1:1127 S RANCHO DR STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2216
Practice Address - Country:US
Practice Address - Phone:888-611-0870
Practice Address - Fax:888-714-4996
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT0864106S00000X
NVRBT19-98036106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician