Provider Demographics
NPI:1023675493
Name:HODGE, AMY (BCBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:CHRISTIANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7728 COUNTY ROAD 229
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-6830
Mailing Address - Country:US
Mailing Address - Phone:325-338-7718
Mailing Address - Fax:
Practice Address - Street 1:7728 COUNTY ROAD 229
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510-6830
Practice Address - Country:US
Practice Address - Phone:325-338-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst