Provider Demographics
NPI:1689609968
Name:INDERMUEHLE, AMY R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:R
Last Name:INDERMUEHLE
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 1:109 CORONADO CT
Mailing Address - Street 2:BUILDING 7
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4929
Mailing Address - Country:US
Mailing Address - Phone:970-222-0524
Mailing Address - Fax:
Practice Address - Street 1:109 CORONADO CT
Practice Address - Street 2:BUILDING 7
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4929
Practice Address - Country:US
Practice Address - Phone:970-676-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2821103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28429877Medicaid
CO671759OtherANTHEM BCBS PROVIDER NUM
CO28429877Medicaid
CO671759OtherANTHEM BCBS PROVIDER NUM