Provider Demographics
NPI:1871390690
Name:GREEN, AMBER BRIANNA (MAT, SPED, RBT, PLBA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:BRIANNA
Last Name:GREEN
Suffix:
Gender:
Credentials:MAT, SPED, RBT, PLBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 TEACO RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3239
Mailing Address - Country:US
Mailing Address - Phone:870-565-9776
Mailing Address - Fax:870-565-9740
Practice Address - Street 1:410 TEACO RD
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3239
Practice Address - Country:US
Practice Address - Phone:870-565-9776
Practice Address - Fax:870-565-9740
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025005579103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst