Provider Demographics
NPI:1710455217
Name:DAVIES, AMY LYN (LPC, CAC II)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LPC, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3056 COUNTY FAIR LN UNIT 3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3268
Mailing Address - Country:US
Mailing Address - Phone:970-217-6123
Mailing Address - Fax:
Practice Address - Street 1:2726 ILLINOIS DR APT 203
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3689
Practice Address - Country:US
Practice Address - Phone:970-217-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014246101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional