Individual
AMANDA JO BROUGHTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA, LBA-OR
Contact information
Practice address
339 W BROADWAY APT 3, EUGENE, OR 97401-2883
(949) 326-8894
Mailing address
339 W BROADWAY APT 3, EUGENE, OR 97401-2883
(949) 326-8894
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
OR
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500693767
—
OR
Enumeration date
07/07/2015
Last updated
01/06/2017
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