Provider Demographics
NPI:1962866012
Name:WATERS, AMANDA (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 FALL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-4136
Mailing Address - Country:US
Mailing Address - Phone:801-693-1192
Mailing Address - Fax:
Practice Address - Street 1:4225 FALL RIVER DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-4136
Practice Address - Country:US
Practice Address - Phone:801-693-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT18622106H00000X
COMFT.0002205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist