Healthcare Provider Details

I. General information

NPI: 1013835107
Provider Name (Legal Business Name): AMANDA POIRIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BOULDER CRESCENT ST STE 201
COLORADO SPRINGS CO
80903-3358
US

IV. Provider business mailing address

4136 BAYTOWN DR
COLORADO SPRINGS CO
80916-3025
US

V. Phone/Fax

Practice location:
  • Phone: 719-966-7037
  • Fax: 719-654-1112
Mailing address:
  • Phone: 610-390-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: