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General NPI Number Information
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NPI Number | 1962166876
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Entity Type | Individual
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Provider Name | AMANDA HART
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Gender | Female
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 2060 W 10TH AVE APT 202
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City | BROOMFIELD
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State | CO
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Zip | 80020-6703
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Country | US
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Telephone | 704-579-1290
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Fax |
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Provider Business Mailing Address
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Address Line | 2060 W 10TH AVE APT 202
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City | BROOMFIELD
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State | CO
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Zip | 80020-6703
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Country | US
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Telephone | 704-579-1290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC.0017526
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC0017526
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License Number State | CO
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