Individual provider Active NPI

Amanda Eubanks, BCBA

  • Behavior Analyst
  • Cornelius, NC
National Provider Identifier
1770056145
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-18-34016 Issued in NC
Practice address
19615 Liverpool Pkwy Ste B
Cornelius, NC 28031-4075
Phone
(818) 241-6780
Fax
(800) 819-7806
NPI assigned
Jan 8, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Behavior Analyst 103K00000X 1-18-34016 NC Primary

Addresses

Primary practice location

19615 Liverpool Pkwy Ste B
Cornelius, NC 28031-4075

Mailing address

PO Box 767938
Roswell, GA 30076-7938
Phone (818) 241-6780

Other practice location 1

2919 Breezewood Ave Ste 202
Fayetteville, NC 28303-5283
Phone (910) 484-1711

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Autism Learning Partners, LLC Behavior Analyst PastSince Jul 1, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1770056145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767938",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300767938",
            "telephone_number": "818-241-6780",
            "fax_number": "800-819-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19615 LIVERPOOL PKWY STE B",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314075",
            "telephone_number": "818-241-6780",
            "fax_number": "800-819-7806"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2919 Breezewood Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283035283",
            "country_code": "US",
            "telephone_number": "910-484-1711",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EUBANKS",
        "first_name": "AMANDA",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-01-08",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "1-18-34016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.