Healthcare Provider Details

I. General information

NPI: 1265431407
Provider Name (Legal Business Name): AMY B. CROCKETT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 N CLARKSON ST
DENVER CO
80218-1030
US

IV. Provider business mailing address

641 YORK ST
DENVER CO
80206-3745
US

V. Phone/Fax

Practice location:
  • Phone: 303-818-5540
  • Fax:
Mailing address:
  • Phone: 303-818-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2526
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: