MEDICARE: MS. AMBERLY R SMITH M.S. MMFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1700265501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMBERLY R SMITH M.S. MMFT

Provider Business Mailing Address
First Line	:	1740 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1009
Country	:	US
Telephone Number	:	970-472-1207
Fax Number	:	970-493-1305

Provider Business Practice Location Address
First Line	:	1740 S COLLEGE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1009
Country	:	US
Telephone Number	:	970-472-1207
Fax Number	:	970-493-1305

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

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	05/26/2015

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