Healthcare Provider Details

I. General information

NPI: 1245012004
Provider Name (Legal Business Name): AMERYST SWANSON-VALENTINE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13575 E 104TH AVE UNIT 300
COMMERCE CITY CO
80022-8401
US

IV. Provider business mailing address

13575 E 104TH AVE UNIT 300
COMMERCE CITY CO
80022-8401
US

V. Phone/Fax

Practice location:
  • Phone: 303-601-2303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0023042
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: