Provider Demographics
NPI:1619480563
Name:LADEBUE, AMY CHRISTINE (MAC, BA, NLC)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:CHRISTINE
Last Name:LADEBUE
Suffix:
Gender:F
Credentials:MAC, BA, NLC
Other - Prefix:
Other - First Name:SACRED TREE
Other - Middle Name:
Other - Last Name:COUNSELING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2596 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1330
Mailing Address - Country:US
Mailing Address - Phone:720-289-0623
Mailing Address - Fax:
Practice Address - Street 1:2596 MOORE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:720-289-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CONLC.0108116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health