Provider Demographics
NPI:1134335904
Name:ANNESLEY, AMY LEE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:LEE
Last Name:ANNESLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W 6TH AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1881
Mailing Address - Country:US
Mailing Address - Phone:720-419-4473
Mailing Address - Fax:
Practice Address - Street 1:2095 W 6TH AVE STE 213
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1881
Practice Address - Country:US
Practice Address - Phone:720-419-4473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3367104100000X
COCSW.099231371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200522006Medicare ID - Type Unspecified