=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053116020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY KING PSYCHOLOGY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2025
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7200 S ALTON WAY STE A140
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80112-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-306-1858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 OLEANDER ST
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80109-9583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-306-1858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMY KING
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 720-306-1858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------