MEDICARE: AMY MARISSA MAXWELL LPC, LCPC, LCAT

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
1	101YP2500X	Professional Counselor	0017549	CO
2	101YP2500X	Professional Counselor	92195	TX
3	221700000X	Art Therapist	002488-01	NY
4	101YM0800X	Mental Health Counselor	CC7526	ME
5	101YM0800X	Mental Health Counselor	TPMC1981	FL

General Provider Information

NPI Number	:	1679176515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARISSA MAXWELL LPC, LCPC, LCAT

Provider Business Mailing Address
First Line	:	1086 10TH ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-7261
Country	:	US
Telephone Number	:	720-663-1296
Fax Number	:

Provider Business Practice Location Address
First Line	:	1086 10TH ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80302-7261
Country	:	US
Telephone Number	:	720-663-1296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	12/23/2025

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