Healthcare Provider Details

I. General information

NPI: 1902387350
Provider Name (Legal Business Name): AMANDA LEE STEPHENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6507 S SANTA FE DR
LITTLETON CO
80120-2910
US

IV. Provider business mailing address

1693 QUENTIN ST
AURORA CO
80045-2518
US

V. Phone/Fax

Practice location:
  • Phone: 303-730-8858
  • Fax:
Mailing address:
  • Phone: 720-848-3000
  • Fax: 720-848-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0018117
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: