Provider Demographics
NPI:1114408713
Name:MYHRE, AMY L (LSW, MSW, SWC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:MYHRE
Suffix:
Gender:F
Credentials:LSW, MSW, SWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 273124
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-3124
Mailing Address - Country:US
Mailing Address - Phone:970-449-2231
Mailing Address - Fax:
Practice Address - Street 1:40047 COUNTY ROAD 31
Practice Address - Street 2:
Practice Address - City:AULT
Practice Address - State:CO
Practice Address - Zip Code:80610-9721
Practice Address - Country:US
Practice Address - Phone:970-449-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0107950101Y00000X
COLSW.0009923949104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor