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General NPI Number Information
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NPI Number | 1962334219
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Entity Type | Individual
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Provider Name | AMANDA JESSICA PHILLIPS ACD.0002692
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Gender | Female
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 443 HIGHWAY 105
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City | PALMER LAKE
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State | CO
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Zip | 80133-9003
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Country | US
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Telephone | 719-955-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 1383 LAKELAND GRV APT 306
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City | MONUMENT
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State | CO
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Zip | 80132-6255
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Country | US
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Telephone | 719-955-1800
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACD.0002692
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License Number State | CO
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