Healthcare Provider Details

I. General information

NPI: 1730406190
Provider Name (Legal Business Name): AMANDA ELIZABETH BRICKER M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 HIGHWAY 82
GLENWOOD SPRINGS CO
81601-9435
US

IV. Provider business mailing address

PO BOX 40
GLENWOOD SPRINGS CO
81602-0040
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-2583
  • Fax: 970-928-8852
Mailing address:
  • Phone: 970-945-2241
  • Fax: 970-945-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5619
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: