Provider Demographics
NPI:1407104599
Name:GROVERT, AMANDA J (PSYD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:GROVERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 S STEELE ST
Mailing Address - Street 2:STE 950
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2805
Mailing Address - Country:US
Mailing Address - Phone:720-446-6218
Mailing Address - Fax:
Practice Address - Street 1:50 S STEELE ST
Practice Address - Street 2:STE 950
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2805
Practice Address - Country:US
Practice Address - Phone:720-446-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0003819103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88120881Medicaid
CO265170YLUMMedicare UPIN