Provider Demographics
NPI:1144004128
Name:RIDDLE, AMY LYNN (RBT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1001 BELLCREST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-5532
Mailing Address - Country:US
Mailing Address - Phone:315-804-2441
Mailing Address - Fax:
Practice Address - Street 1:2400 ELLIS ST
Practice Address - Street 2:
Practice Address - City:VENUS
Practice Address - State:TX
Practice Address - Zip Code:76084-3777
Practice Address - Country:US
Practice Address - Phone:682-877-1234
Practice Address - Fax:682-877-1235
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-286529106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician