Provider Demographics
NPI:1962634584
Name:WILLIAMSON, AMBER VAIL
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:VAIL
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5388 VALENTIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3842
Mailing Address - Country:US
Mailing Address - Phone:207-522-5243
Mailing Address - Fax:
Practice Address - Street 1:5388 VALENTIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3842
Practice Address - Country:US
Practice Address - Phone:207-522-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COPSY0004512103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8416054-2501OtherPSYCHOLOGIST
MA9823OtherCLINICAL PSYCHOLOGY
COPSY0004512OtherCLINICAL PSYCHOLOGY