Healthcare Provider Details

I. General information

NPI: 1609182260
Provider Name (Legal Business Name): AMY BETH MYERS MA, LPC, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FARRAGUT AVE
COLORADO SPRINGS CO
80909-5625
US

IV. Provider business mailing address

2524 TREMONT ST
COLORADO SPRINGS CO
80907-6029
US

V. Phone/Fax

Practice location:
  • Phone: 719-327-2084
  • Fax:
Mailing address:
  • Phone: 719-244-0083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-21940
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0005337
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: