Provider Demographics
NPI:1457069544
Name:KELEHER, AMY (MA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KELEHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 NIWOT MEADOW FARM RD
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4620
Mailing Address - Country:US
Mailing Address - Phone:720-291-4606
Mailing Address - Fax:
Practice Address - Street 1:3445 PENROSE PL STE 240
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1877
Practice Address - Country:US
Practice Address - Phone:303-271-3589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional