Provider Demographics
NPI:1134824626
Name:STOCKLIN, AMY (MFT0002851)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STOCKLIN
Suffix:
Gender:
Credentials:MFT0002851
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 GABRIELLA LN
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-2730
Mailing Address - Country:US
Mailing Address - Phone:925-528-9331
Mailing Address - Fax:
Practice Address - Street 1:221 E 29TH ST STE 201
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2746
Practice Address - Country:US
Practice Address - Phone:970-310-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002851106H00000X
CO0014420106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist