MEDICARE: AMANDA WATERS LMFT

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	106H00000X	Marriage & Family Therapist	18622	UT
2	106H00000X	Marriage & Family Therapist	MFT.0002205	CO

General Provider Information

NPI Number	:	1962866012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA WATERS LMFT

Provider Business Mailing Address
First Line	:	4225 FALL RIVER DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-4136
Country	:	US
Telephone Number	:	801-693-1192
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 FALL RIVER DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-4136
Country	:	US
Telephone Number	:	801-693-1192
Fax Number	:

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

Provider Enumeration Date	:	04/05/2016
Last Update Date	:	07/26/2022

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