Basic Information
| Provider Information | |||||||||
| NPI: | 1679068399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | TLLP, BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8285 S SAGINAW ST STE 7 | ||||||||
| Address2: | |||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484392436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103213001 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9038 CROSS PARK DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379234729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653946612 | ||||||||
| FaxNumber: | 8653157014 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2018 | ||||||||
| LastUpdateDate: | 10/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | N | Eye and Vision Services Providers | Technician/Technologist | 103K00000X | 7401001297 | MI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-20-45946 | 01 | TN | BACB | OTHER |