Healthcare Provider Details

I. General information

NPI: 1912713231
Provider Name (Legal Business Name): AMANDA SUNDEEN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 W COLORADO AVE
COLORADO SPRINGS CO
80904-3840
US

IV. Provider business mailing address

5097 SAND HILL DR
COLORADO SPRINGS CO
80923-8777
US

V. Phone/Fax

Practice location:
  • Phone: 719-247-3152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA SUNDEEN
Title or Position: OWNER
Credential: LPC, LAC, NCC
Phone: 719-247-3152