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General NPI Number Information
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NPI Number | 1518549310
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Entity Type | Organization
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Legal Business Name | AMY MCDANIEL MOLINA, LLC
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 04/22/2021
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Provider Practice Location Address
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Address Line | 323 W DRAKE RD STE 216
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City | FORT COLLINS
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State | CO
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Zip | 80526-8120
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Country | US
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Telephone | 720-900-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 2409 COPPER CREST LN
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City | FORT COLLINS
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State | CO
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Zip | 80528-2400
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Country | US
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Telephone | 970-213-2620
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. AMY MCDANIEL MOLINA
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Credential | PH.D.
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Telephone | 970-213-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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