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NPI Code Detail

MEDICARE: AMY LYNDA JAIME BA

MEDICARE: AMY LYNDA JAIME BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1063699825
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY LYNDA JAIME BA
Provider Business Mailing Address
First Line : 1603 S 12TH ST
Second Line :
City : LAMAR
State : CO
Zip : 81052-4044
Country : US
Telephone Number : 719-336-3647
Fax Number :
Provider Business Practice Location Address
First Line : 3500 1ST ST S
Second Line :
City : LAMAR
State : CO
Zip : 81052-4327
Country : US
Telephone Number : 719-336-7501
Fax Number : 719-336-7453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2008
Last Update Date : 01/23/2008

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