MEDICARE: AMY SUTTON MA, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6355	CO

General Provider Information

NPI Number	:	1922378009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SUTTON MA, LPC, NCC

Provider Business Mailing Address
First Line	:	1720 JET STREAM DR STE 203
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3938
Country	:	US
Telephone Number	:	719-494-5781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 JET STREAM DR STE 203
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-3938
Country	:	US
Telephone Number	:	719-494-5781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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