Provider Demographics
NPI:1609182260
Name:MYERS, AMY BETH (MA, LPC, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:BETH
Last Name:MYERS
Suffix:
Gender:F
Credentials:MA, LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6029
Mailing Address - Country:US
Mailing Address - Phone:719-244-0083
Mailing Address - Fax:
Practice Address - Street 1:17 FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5625
Practice Address - Country:US
Practice Address - Phone:719-327-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-21940103K00000X
CO0005337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74450263Medicaid