Healthcare Provider Details

I. General information

NPI: 1134430739
Provider Name (Legal Business Name): AMBER LAURISSA TROXEL LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER LAURISSA BACH CACIII

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 28 3/4 RD
GRAND JUNCTION CO
81501-5016
US

IV. Provider business mailing address

PO BOX 3807
GRAND JUNCTION CO
81502-3807
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-6023
  • Fax: 970-242-8330
Mailing address:
  • Phone: 970-683-7131
  • Fax: 970-243-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002183
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0007263
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: