Provider Demographics
NPI:1255971909
Name:PRUESS, AMANDA RAE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:PRUESS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 BLAKE ST STE 250
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4889
Mailing Address - Country:US
Mailing Address - Phone:303-907-0574
Mailing Address - Fax:
Practice Address - Street 1:3501 BLAKE ST STE 250
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4889
Practice Address - Country:US
Practice Address - Phone:303-907-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-20-127990106S00000X
106S00000X
CO1-22-62491103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician