Healthcare Provider Details

I. General information

NPI: 1326977893
Provider Name (Legal Business Name): AMANDA J SMITH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 STANLEY CIRCLE DIVE
ESTES PARK CO
80517
US

IV. Provider business mailing address

178 STANLEY CIRCLE DIVE
ESTES PARK CO
80517
US

V. Phone/Fax

Practice location:
  • Phone: 414-430-3134
  • Fax:
Mailing address:
  • Phone: 414-430-3134
  • 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: AMANDA SMITH
Title or Position: OWNER
Credential:
Phone: 414-430-3134